Anthem and Mary Washington Healthcare — Updates

The following message is from Human Resources:

Update for All Anthem Policy Holders

(This notice does not apply to Kaiser Permanente Members)

It is official:  as of January 1, 2012, Mary Washington Healthcare (MWHC) has terminated its provider network agreements with Anthem.  Mary Washington Hospital, including the hospital’s emergency room, Stafford Hospital, including the hospital’s emergency room, the Fredericksburg Ambulatory Surgery Center, and Snowden at Fredericksburg are no longer in-network providers for Anthem.

The complete list of Mary Washington Healthcare facilities and their Anthem status is located at http://www.marywashingtonhealthcare.com/images/stories/graphics/facilitieslist.pdf.  This does not impact the MWHC physician offices, the Mary Washington Freestanding Emergency Department at Lee’s Hill, or the Sleep and Wake Disorders Center- Fredericksburg.

Since agreements weren’t reached, Mary Washington Hospital, Stafford Hospital, the Fredericksburg Ambulatory Surgery Center, and Snowden at Fredericksburg are now considered out-of-network providers under Anthem’s Health plan. Click here for a list of alternative Anthem in-network providers for the Fredericksburg Area.

For employees with out of network coverage:  Employees who elected the “out-of-network” buy up coverage option of the health plan will be covered if they choose to be treated by the MWHC out-of-network facilities. Normally, when receiving services at an out-of-network provider, you would have a higher out-of-pocket responsibility; however, to avoid any monetary disruption to the Anthem members with out-of-network benefits in the community,  Mary Washington Healthcare has committed to honor the in-network benefits.  MWHC will not charge the employee for any costs beyond what their in-network responsibility would have been, thus MWHC will honor in-network deductibles, co pays and co insurance.  Simply stated, you can continue to receive services at the MWHC facilities that are out-of-network with Anthem without incurring any additional out-of-pocket expenses.

How payments are processed for out of network providers:  Please be advised that MWHC will continue to submit claims to Anthem and will bill the patient directly.  Because Anthem does not make direct payments to any out-of-network providers, there is a good chance that Anthem will send the payment to the policy holder to pay the bill.  In these cases, please be sure that MWHC receives the payment.

For employees without the out–of–network coverage:  You will need to first contact Anthem at 1-800-552-2682 to request an exception of coverage for services at one of these out-of-network facilities.  Attached is a list of alternative Anthem in-network providers for the Fredericksburg Area.

For employees who want to change plans or elect out-of-network coverage:  Employees will have the opportunity to change plans or elect out-of-network coverage during the annual Health Benefits Open Enrollment this spring, unless there is a qualifying mid-year event under DHRM policy. To see current costs, you may visit  http://www.dhrm.state.va.us/hbenefits/openenroll11/Premiums2011.pdf  Cost is subject to change each year.  Changes made during open enrollment will be effective July 1.

If you have forgotten which coverage you have:  To confirm whether you elected out-of-network coverage, you may…

• log into EmployeeDirect to review your health benefits election at https://edirect.virginia.gov/EDL/Start.aspx. You will need your employee ID number (which is located on your health card), your date of birth, and create a password; or
• contact Anthem (1-800-552-2682); or
• contact our Benefits Office (X1210 or X1215).

Mary Washington Healthcare has updated their website with FAQs at the following link to assist you in this transition:  http://www.marywashingtonhealthcare.com/awards-a-accreditations/878-attention-anthem-patients. You may also contact the MWHC Anthem hotline number at 540-741-1010 or click here for a PDF version. Anthem’s FAQ’s are available at https://anthemgroup.postclickmarketing.com/Global/FileLib/disruptions/MW-FAQs.pdf.  The Anthem hotline number is 1-866-263-0361.

REMINDER:  In an emergency situation, please call 911 and you will be taken to the closest, most appropriate emergency department.