MemorialCare Patients Insured through Anthem Have Certain Rights Amid Contract Termination

Long Beach Memorial Medical Center. File photo.

Following this week’s revelation that Anthem Blue Cross and MemorialCare Health System have severed ties resulting in loss of coverage for some patients, Assemblyman Patrick O’Donnell today provided a list of legal rights concerning continuity of care.

Story continued below.
S P O N S O R

The contract termination between MemorialCare and Anthem ended August 15 after several months of negotiations, leaving some Anthem members that use the hospitals, including Long Beach Memorial Medical Center, without an in-network provider and without medical coverage.

This termination does not impact Anthem members part of the Anthem-Vivity plan, Boeing employees or Anthem members on Medicare since these are different contracts, stated Lori Weaver, executive director of Managed Care at MemorialCare.

“It is important to note that physicians’ contracts are remaining in place so patients do not need to change their physicians or interrupt scheduled services,” Weaver added.

For those patients who are impacted, O’Donnell’s office has compiled the following information:

  • If you or a dependent was hospitalized at the time of the change or before, you should continue to receive uninterrupted care at MemorialCare facilities until you are discharged. The in-network benefit levels will remain the same.
  • If you began a course of treatment before the change on August 15, you may still be able to receive in-network benefits for certain conditions, including treatment for: acute medical or behavioral condition; a serious chronic condition; pregnancy (regardless of trimester); a terminal illness; newborn children from birth to 36 months; a surgery or other procedure authorized by Anthem or an HMO prior to the termination date that was scheduled to occur 180 days after August 15.
  • You are eligible to seek continuity of care authorizations by contacting Anthem at the number on your insurance card. The request form can also be found here and Anthem's customer service center can be reached at this number: (877) 800-7339.
  • If you are concerned about access, benefit coverage, or disruptions in your care, you can also call the Department of Managed Health Care (DMHC): (888) 466-2219. The following link connects to a form through which you are able file a formal complaint via the DMHC: file a formal complaint.

Long Beach Memorial Medical Center has additional information available here and Long Beach city employees can find additional information from human resources here.

MemorialCare includes the following hospitals: Long Beach Memorial Medical Center, Community Hospital of Long Beach, Miller Children’s and Women’s Hospital of Long Beach, Orange Coast Memorial Medical Center and Saddleback Memorial Medical Center.


 

O’Donnell first brought the issue to the public’s attention Wednesday. Since then, other local elected officials have spoken out calling on the two entities to head back to the negotiating table.

“By dropping Long Beach Memorial Medical Center as an in-network provider, Anthem Blue Cross took healthcare decisions out of the hands of doctors and families,” said state Sen. Ricardo Lara, who represents portions of Long Beach and who in February introduced a bill that would provide a universal healthcare system in California. “Anthem Blue Cross needs to immediately restore services for Long Beach residents and enter negotiations with Long Beach Memorial Medical Center.”


 

Mayor Robert Garcia said in a Facebook post late yesterday that he is in close communication with the parties involved and is hopeful that the issue will get resolved as soon as possible.

“We are very concerned about the dispute between Anthem Blue Cross and MemorialCare,” Garcia stated. “We have thousands of Long Beach residents and city employees who are part of the network.”

Both Anthem and MemorialCare have issued statements with regard to the termination of their contract, with Anthem spokesman Colin Manning blaming MemorialCare for the breakdown in negotiations “in order to demand an excessive increase in reimbursement rates.”

"Anthem has been in discussions with MemorialCare for months in an attempt to resolve this matter,” Manning stated Wednesday. “Discussions continued until the eleventh hour when MemorialCare made the decision to terminate the Anthem contract with its five hospitals. We’re disappointed we were not able to reach an agreement with MemorialCare that would allow us to achieve the appropriate balance between access and affordability for our members."

Adding to a previously released statement by MemorialCare Wednesday, Weaver said it is “unfortunate that Anthem is characterizing a modest, fair and reasonable offer as excessive.”

“We are asking Anthem to recognize and honor the value and importance of the services we provide to our communities on behalf of our patients, our physicians and our hospitals by negotiating a modest annual increase so that we are reimbursed fairly for the exceptional medical care we offer to the Anthem members that we serve,” according to a statement from MemorialCare.



Share this:


NEVER MISS A STORY