Premier Healthcare, Anthem reach deal; in-network coverage starts Thursday 4-4-13
Premier Healthcare in Bloomington and Anthem Blue Cross Blue Shield have reached an agreement nearly five months after the physician group left the insurance giant’s provider network.
Premier Healthcare will renew its participation in Anthem’s preferred provider network beginning at 12:01 a.m. Thursday, according to a statement on the group’s website. All patients with Anthem insurance will return to in-network status at that time.
“This has been a difficult period, and the providers and staff of Premier Healthcare thank you for your continued support,” the statement said. “We look forward to welcoming back any and all of our patients who have had to make the difficult choice of changing their provider. Thank you again for your patience, and we look forward to being your healthcare provider of choice.”
Latest from Anthem;
Important notice regarding Premier Healthcare
Your action may be required
As of November 1,2012, Premier Healthcare in the Bloomington, IN area is no longer a participating provider with the Anthem BlueCross BlueShield or BlueCross BlueShield of Alabama networks. If you use Premier Healthcare, please see below for your options.
For the remainder of 2012…
From November 1, 2012, to December 31,2012, GE will allow you to continue to see your Premier Healthcare provider at the in-network level of benefits. All claims paid during this time will pay according to the in-network level of benefits. This will allow you time, if you choose, to transition to a new provider. If you are currently undergoing an active course of treatment, you may be eligible for transition of care, please contact Anthem.BlueCross BlueShield directly for assistance.
For 2013 …
Starting January 1, 2013, if Premier Healthcare is still not in the BlueCross BlueShield network, they will be considered an out-of-network provider. You can continue to see these providers, however, the services will be considered out-of-network. subject to a deductible, and you will be responsible for higher out-of-pocket expenses. Please also note that preventive benefits are not covered at an out-of-network provider.
The Premier Healthcare network is available at in-network benefits through GE Health Benefits administered by UnitedHealthcare.
You have an opportunity to select UnitedHealthcare as your health plan administrator for GE Health Benefits prior to January 1,2013. Please note that electing a new health plan administrator will not change your health plan Option. A new election of your health plan administrator will be effective for the 2013 plan year and will also apply to any dependents you have enrolled.
To change your health plan administrator to UnitedHealthcare, you must contact the GE Benefits Center at 1-866-234-8920 weekdays from 9 a.m. to 5 p.m., Eastern time before December 28,2012.
To find providers in the UnitedHealthcare network, visit their Web site at: www.myuhc.com or contact their Customer Service Department at: 1-866-756-4792.
November 16, 2012
We are writing to share a network status change concerning a provider from which you
or one of your family members have recently received services. Effective November 1,
2012, Premier Healthcare is no longer considered a participating provider with Anthem
Blue Cross Blue Shield.
You may continue to use Premier Healthcare between November 1, 2012 and
December 31, 2012 at the in-network level of benefits.
Effective January 1, 2013, if you continue to use Premier Healthcare. your claims will be
paid at the out-of-network coinsurance level and preventive care will not be covered out-of-
There are other in-network providers in the area that are available to you. Please
contact Anthem for assistance at the numbers below for a complete listing of
If you are currently undergoing an active course of treatment, you may be eligible for
transition of care until your current course of treatment can be transitioned to an in-network
provider. Please contact Anthem directly for assistance if this applies to you.
You may contact Anthem customer service (GE Health Choice members: 866-804-9321
and GE Health Benefits members: 855-402-6844) to obtain information about other in network
providers that may be available to you. Additionally, Health Coach from GE can also assist you with provider recommendations. You may contact Health Coach at 866-272-6007.
We appreciate your continued support and thank you for your cooperation during this
Anthem Blue Cross Blue Shield
Call Anthem for a list of Doctors still in the network.
You can call Anthem at 1-855-402-6844.
You can also call the GE health coach at 1-866-272-6007 option 2.
You can request a list of Doctors in a specific field to make it easier to find one.
11-3-12 Out of Network benefits with Anthem Insurance
Because of the ongoing dispute between Anthem and Premeir Health I have been asked several questions regarding the Out of Network benefits.
I spoke with our Anthem rep today and this was her explanation for Out of Network charges
If you have NOT met your deductible yet, the insurance pays 0, the allowable in-network charge is credited as part of your deductible. Any amount you have to pay over that does not apply. Example: the doctor charges $100 for a visit, the allowable in-network charge is $80, you pay the $100 and your deductible gets credit for $80.
If you are in the 80/20 deductible the insurance will pay 60% of the allowable in-network charge. You will be responsible for 20% plus any amount over the in-network rate. ( If the visit is $100 and the in network rate is $80 then the insurance would pay 60% of $80 or $48. Your responsibility would be the remaining 40% or $12 + the difference between the charge and the allowed amount (100-80=20) your total amount to pay would be $32. The amount credited to your deductible would be $80.
If you have reached your Maximum Out of Pocket the insurance will pay 100% of the allowable in-network charge. If you are charged $100 for the visit, the in-network is $80 the insurance will pay 100% the $80 but you will be responsible for the other $20.
If you need more specific answers contact the Anthem BC/BS office 1-855-402-6844. They can assist you on your individual needs.
11-1-12 Healthcare Service Alert
Effective November 1, 2012 IMA/Premier Health and their affiliates are no longer an IN Network provider. They have failed to reach an agreement with Anthem BC/BS, and as a result YOUR coverage when using these providers will be reduced to out of network costs.
A call to Landmark Priemier Health today verified that an Anthem BC/BS insured patient would have to pay $40 upfront costs to see the doctors. All other procedures will be billed at out of nework rates (no discount and 60/40)
If you are scheduled for an office visit, labwork, tests, x-rays or any other procedures use caution and check on your coverage before proceeding. Procedures that were covered at in network costs will now be significantly higher.
Until the isuues are resolved you can get non-lifethreatening healthcare at IU Southern Indiana Physicians Clinics, First Health, or CVS Minuteclinics to name a few. Labwork, xrays, tests can also be done at IU Bloomington hospital. (This is not intended as a referral, but as a suggestion to other available facilities.)
update: Nov 1 4:45 pm I contacted Premier Healthcare to get a list of providers and facilities. I was strongly encouraged to have each insured call for themself. They are working with individuals on a case by case situation. You can go to http://premierhealthcare.org/
Carven spoke with our HR department today and was told that Corporate will be reaching out to Anthem on Monday. Hopefully they can get this matter resolved quickly.