December 22, 2020
Area(s) of Interest: Payor Contracting Commercial Payors
The California Medical Association (CMA) has learned that the contract between Hill Physicians Medical Group and Anthem Blue Cross will be terminated for the Medi-Cal managed care product effective January 1, 2021. According to information filed by Anthem with the Department of Managed Health Care (DMHC), the termination will affect approximately 18,307 enrollees, 17,444 of which are in Sacramento and 863 of which are in San Francisco County.
According to the health plan filings, Anthem will transfer the majority of patients to alternative medical groups in the impacted areas, including Nivano Medical Group (12,064), River City Medical Group (4,374) and Asian American Medical Group (351). Anthem is pursuing direct contracting with approximately 1,512 physicians in affected areas. The termination only applies to the Med-Cal managed care product and does not affect the Anthem-Hill Physicians HMO or PPO (including applicable ACOs) products.
Patients may also be able to continue to see their physicians under California’s continuity of care law. These laws allow that patients with an acute condition, serious chronic condition, duration of a pregnancy, duration of a terminal illness, care of children between birth and 36 months, or for the performance of a surgery or other procedure that has been authorized, may qualify to request continuity of care. To request continuity of care, patients should call the health plan number on the back of their ID cards.
For more information on continuity of care requirements, see CMA health law library document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.”
Physicians are encouraged to obtain updated insurance information and verify eligibility at the time of scheduling, if possible. While the health plan filings indicate that 66% of patients will retain their current primary care physician (PCP), patients who were assigned to a new physician or medical group can call Anthem member services to request a PCP change, if necessary.
Physicians who have additional questions regarding the transition can contact Hill Physicians Medical Group at (800) 445-5747 or Anthem Blue Cross at CAcontractsupport@anthem.com.