Hazel Hawkins Memorial Hospital provided the following news release Aug. 4, 2022:
Anthem Blue Cross PPO (Anthem), the second largest health insurer in the United States, is refusing to appropriately pay Hazel Hawkins Memorial Hospital (HHMH) for health care services. Anthem, a for-profit business, insures more Preferred Provider Organization (PPO) members in California than any other insurance company.* Anthem has until August 10, 2022, to align their payment with the market rate or HHMH will be “out-of-network” for Anthem PPO members. Emergency Medical Care is not affected by out-of-network status.
“We began negotiating for an appropriate market rate adjustment in 2020,” said Mark Robinson, Chief Financial Officer. According to a 2021 Kaiser Family Foundation report, the average premiums for family insurance coverage has risen faster than inflation over the last 5 years. “HHMH, the only hospital within 25 miles, is expected to provide care for Anthem PPO members at less than market rates,” Robinson commented.
Negotiations have been ongoing for nearly three years. This past January 2022, officials with HHMH provided Anthem notice of contract termination, with the hope that an appropriate rate would be offered.
Unfortunately, a termination notice is the only tool we have to get Anthem’s attention,” said Steven M. Hannah, Chief Executive Officer. “Access to quality healthcare is a right for the communities we serve, yet our organization must advocate for the financial stability of our District. Anthem, like all other commercial payers, needs to provide market competitive reimbursement for the health care services rendered by Hazel Hawkins Memorial Hospital,” Hannah added.
Ideally, Anthem will provide an appropriate rate increase and this situation will be rectified prior to August 10, 2022. If Anthem cannot reach a financially equitable agreement with HHMH by August 10, 2022, HHMH will no longer be a contracted provider with Anthem Blue Cross PPO. This means the care Anthem PPO members receive from HHMH will be out-of-network on August 11, 2022. Hazel Hawkins Memorial Hospital has established a dedicated team to help Anthem PPO members navigate access to care and continuity of care. They can be reached by phoning,
(831) 205-5710.
HHMH officials stand ready to negotiate in earnest or take whatever other steps are necessary to receive appropriate reimbursement for the care we provide and being back in network for Anthem Blue Cross PPO members.
Anthem Blue Cross PPO Members concerned about the impact of out-of-network care can file a complaint with the Department of Managed Health Care, (888)466-2219 or www.dmhc.ca.gov, or contact Anthem Blue Cross Customer Service, (844) 971-0117.
*https://www.benefitscafe.com/insurance-companies/
Frankie Gallagher
Associate Director of Marketing
Hazel Hawkins Memorial Hospital
About Hazel Hawkins Memorial Hospital
Hazel Hawkins Memorial Hospital, established in 1907, is licensed as General Acute Care Hospital currently operating with Critical Access designation. As a public agency, our healthcare system provides timely, efficient care with compassion and a commitment to excellent service. Hazel Hawkins Memorial Hospital, (HHMH) is meeting the healthcare needs of San Benito County through a coordinated continuum of outpatient primary and medical specialty care as well as diagnostic services across multiple locations. Learn more about Hazel Hawkins Memorial Hospital and our health system by visiting www.hazelhawkins.com