April 14, 2021
Area(s) of Interest: Practice Management Payor Issues and Reimbursement
The California Medical Association (CMA) has learned that the contract between Dignity Health California and Anthem Blue Cross is set to terminate for its commercial PPO, Prudent Buyer, HMO, Medicare Advantage, and Medi-Cal HMO lines of business effective July 15, 2021, if both parties are unable to reach a new agreement. According to the Anthem Notice of Termination of Prudent Buyer Plan Participating Physician Agreement sent out to approximately 2,000 Prudent Buyer physicians, as a condition of their contracts they must maintain admitting privileges at an in-network hospital. If Dignity Health and Anthem cannot renegotiate their agreement by July 15, 2021, avoiding termination, and physicians’ admitting privileges are limited to Dignity Health hospitals, they must obtain admitting privileges at another in-network hospital. Failure to do so could result in termination of their Anthem contracts.
CMA has inquired with the California Department of Managed Health Care (DMHC) to obtain more information regarding the number of Anthem enrollees that would be impacted by the termination and will provide updates as details are available.
This issue comes on the heels of a similar contract renegotiation involving Dignity Health and Aetna. However, CMA was advised that the two parties did reach a three-year agreement that is retroactive to April 1 (with no lapse in the agreements); there is no impact to physician contracts.
In the event of an Anthem-Dignity Health contract termination on July 15, affected patients may be able to continue to see their physicians under California’s continuity of care law. Health plans, at the enrollee’s request, must provide for the completion of covered services as follows:
- For an acute condition
- For a serious chronic condition
- For the duration of a pregnancy
- For the duration of a terminal illness
- For the care of children between birth and 36 months
- 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 who have additional questions can contact Dignity Health by emailing Debbie Esparza at Debbie.Esparza@DignityHealth.org or Jennifer Kurkjian at Jennifer.Kurkjian@DignityHealth.org.
Physicians can also contact Anthem Blue Cross at CAcontractsupport@anthem.com and Aetna at (888) 632-3862.