Norton Refuses Mediation, Cancels Anthem Contract
Other Louisville providers stand ready to serve Anthem’s customers
Louisville, KY–Anthem Blue Cross and Blue Shield of Kentucky today announced that Norton Healthcare cancelled its contract at midnight, June 30, 2009. Norton had refused several offers to enter into non-binding, third party mediation to resolve the dispute and now becomes the only health system in Kentucky to not have a contract with the state’s largest health benefits company.
Even without Norton, Anthem still has the largest network of providers, hospitals, and physicians in Kentucky.
“We are very disappointed in Norton’s actions, but Anthem members should rest assured that they still have a host of excellent health care options in Louisville,” said Deb Moessner, president of Anthem in Kentucky. Specifically, Moessner pointed to the extensive provider options offered by Jewish Hospital, Baptist East, and University Hospital that are in-network alternatives to Anthem members.
“Jewish Hospital & St. Mary’s HealthCare has over 220 physicians in our employed network, six emergency rooms, and multiple in-patient and outpatient facilities to care for the needs of our community,” said Jeff Polson, vice president of marketing and communications for JHSMH.
“Baptist Health is poised through recent growth to help patients in the Louisville area who are affected by this unexpected change – a change that’s never easy to make. We have two full-service hospitals in Louisville and La Grange, in addition to outpatient facilities in Middletown and at Eastpoint. Our network of physicians is growing, and we offer urgent care and after-hours care for patients through Baptist Urgent Care and two of our BaptistWorx(R) facilities in the south end,” said Baptist East marketing and public relations director Rebecca Brown.
U of L Health Care spokesman David McArthur said, “U of L Health Care would like to remind the thousands of families and individuals covered under Anthem insurance plans that University Hospital, the James Graham Brown Cancer Center, and the University of Louisville Physicians all have existing, in-network contracts with Anthem insurance. We are happy to make our services and facilities available to all members of our community.”
Kosair Children’s Hospital
“Because some pediatric hospital services may not be available elsewhere in the area, Anthem is going to take parents and children out of the middle of this dispute by paying Anthem members at the in-network rate and at the rate Norton has requested in their proposal to us for services performed at Kosair,” said Moessner. “This is the right thing to do for our community.”
“After Norton terminated our contract, we received a clear message from our customers that they want continued in-network access to Kosair,” said Moessner. Although Anthem has agreed to pay higher rates for services performed at Kosair, there will still be a significant overall savings in the cost of care since Norton’s adult hospitals are out of network.
The dispute began in December 2008 when Norton announced its intention to leave the Anthem network 15 months before the contract was due to expire. Norton, already one of the most expensive providers in Louisville, did not waver from its demands for an immediate double-digit increase in reimbursement rates from Anthem in the middle of their existing contract period. Giving in to Norton’s demands would have dramatically increased medical costs for Anthem members and local employers.
Anthem members who have questions about the upcoming transition are encouraged to visit http://group.anthem.com/norton or call the customer service number on the back of their Anthem ID card.
What hospitals are affected by this?
Norton Audubon Hospital
Norton Hospital
Norton Suburban Hospital
Kosair Children’s Hospital
What Anthem health plans would be affected?
Blue Access, Blue Preferred, Blue Traditional, Medicare Advantage HMO/PPO
Does this termination affect Norton-employed physicians?
Yes. More than 400 physicians employed by Norton Health System will also be considered out of network July 1, 2009. Beginning July 1, 2009, Anthem members will face higher out of pocket costs when receiving services from a Norton-employed physician. To check the network status of a physician, members should contact the customer service number on the back of their Anthem ID card, or click on “Find a Doctor” at www.anthem.com.
If Norton facilities were to go out of Anthem’s network, are there other in-network facilities in the area?
Yes. Most services available at a Norton Hospital are available elsewhere in Louisville at in-network hospitals such as Jewish Hospital, Baptist Hospital East or University. Because some pediatric hospital services may not be available elsewhere in the area, Anthem is going to take parents and children out of the middle of this dispute by paying members at the in-network rate and at the rate Norton has requested in their proposal to us.
What happens if a member goes to a Norton-affiliated hospital after July 1, 2009?
It is recommended that Anthem members begin to consider the other in-network options in the area for health care needs.
What about emergency care?
After July 1, 2009, if an Anthem member chooses one of these hospitals for emergency care and the hospital charges more than Anthem’s benefits allow, the member may have to pay the difference. There are exceptions for life threatening emergencies and other circumstances.
What happens if a member is an inpatient at one of the above facilities at the time of the termination?
If a member is an inpatient on the date of the termination, the above hospitals must continue to honor our in-network reimbursement rate and provide care for 60 days or until they are discharged from the hospital.
Members want to avoid out of network charges. But what if their doctor typically admits his/her patients to a Norton-affiliated hospital and doesn’t have admitting privileges to alternate Anthem-network hospitals?
Members should talk to their doctor about other options. Many doctors have admitting privileges at more than one Louisville hospital.
Anthem members who have questions about the upcoming transition are encouraged to visit http://group.anthem.com/norton or call the customer service number on the back of their Anthem ID card.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, an independent licensee of the Blue Cross Blue Shield Association. (R)ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Kentucky is available at www.anthem.com.
The Anthem Blue Cross and Blue Shield companies are independent licensees of the Blue Cross and Blue Shield Association.
Registered marks Blue Cross and Blue Shield Association.
Contact: Tony Felts
o: 502-889-2113
c: 317-439-6751
/PRNewswire — July 1/
Source: Anthem Blue Cross and Blue Shield of Kentucky
Web Site: http://www.anthem.com/
