Important update on Anthem Blue Cross contract negotiations

Anthem Blue Cross is notifying its HMO plan members that the insurer is moving their care away from UC Davis Health as of March 1. These members are being assigned to a new provider because UC and Anthem have not reached an agreement on a new contract to pay for their members’ care.

Anthem has been informing physicians since last August of its intention to end the contract with UC.  Initially, Anthem’s contract was due to expire on Jan. 1, but it was extended until Feb. 29 as negotiations continued. No agreement has been reached and it looks like the contract will expire before there is a new agreement.

It is Anthem’s decision to take this step and disrupt patient care, and it is disappointing that they are taking this unnecessary action, which will create an undue burden on both patients and clinicians.

UC beneficiaries not impacted

This contract issue does not impact patients who receive benefits through UC Davis. UC has a separate contract that covers patient care for UC beneficiaries, and that contract is not ending at this time.  Specifically, these current Anthem Blue Cross-UC Health negotiations do not apply to:

• UC employees and retirees who have coverage through the UC Care, UC Health Savings and UC Core plans
• UC students with UC SHIP coverage
• UC medical residents and UC clinical fellows in the UC Residents and Fellows Anthem Blue Cross PPO plan
• UC retirees who have UC-sponsored Medicare supplemental coverage through the Medicare PPO, Medicare PPO no Rx and High Option plans 

The termination of this Anthem contract will impact the following Anthem-covered patients:

• Patients who selected an Anthem Blue Cross plan through the California Public Employees’ Retirement System
• Patients who selected an Anthem Blue Cross plan through their employer
• Patients who purchased an Anthem Blue Cross plan in the Covered California marketplace
• Patients with Medicare Advantage plans administered by Anthem Blue Cross
• Patients with Medi-Cal plans administered by Anthem Blue Cross
• UC medical residents and clinical fellows who are enrolled in the Anthem UC Medical Residents and Fellows HMO plan (none at UC Davis Health)

Anthem PPO patients will be impacted next

UC Davis Health providers will be out of network for Anthem PPO patients starting on March 1. They can still receive care from UC Davis Health but may have a significantly higher share of the cost as the patient’s responsibility. (Patients under active treatment may qualify for continued time-limited in-network benefits under the required Continuity of Care program.)

Appointments for Anthem PPO patients should not be automatically canceled; instead, these patients need to be informed of their share of cost changes on and after March 1, and their share of the cost will be significantly higher if they do not qualify for Continuity of Care.

In mid-January, we will follow up with impacted Anthem Blue Cross HMO patients to ensure they know how to request Anthem Blue Cross’s approval for Continuity of Care (for ongoing or current treatment plans).

What to say to patients 

• Patients impacted by the HMO block transfer can apply to Anthem Blue Cross for Continuity of Care by completing and mailing this form to Anthem Blue Cross. PPO patients are also eligible for Continuity of Care and can be encouraged to apply if they ask how they can continue receiving care from us.
• The decision to grant Continuity of Care is entirely up to Anthem. It is likely that Anthem will not respond to patients promptly, as there will be tens of thousands of requests from patients for Continuity Care (since UC cares for many patients who are chronically ill). We are working to support our teams through this, and our patients, as they complete Continuity of Care forms.
• We have developed a flier that can be printed and provided to patients for more information. This flier version is two-sided and can be cut in half to save paper.
• We have also developed a document to help answer questions patients may ask team members.
• We will also update our website regularly at ucdavis.health/anthem so patients can be directed there for more information, to find Anthem’s Continuity of Care form, and a list of other health plans with contracts with UC Davis Health.

What happens next

Unfortunately, negotiations with Anthem are not going well. UC needs single-digit rate increases to cover the costs of inflation, rising costs for medical supplies, salary increases, and upkeep of our facilities. The majority of Anthem’s proposals have been well below the costs of inflation, effectively resulting in cuts to our reimbursement rates. These cuts would lead to reductions in our ability to provide care for patients. Meanwhile, Anthem has been charging double-digit premium increases, and its parent company, Elevance, has been reporting record profits and promising investors more in the future.

We believe Anthem can and should cover the increased costs of care for its members. We also believe Anthem needs UC to establish its network adequacy for membership. Unfortunately, Anthem’s leadership seems ready to inconvenience patients and take them out of network for some period of time as part of an effort to try to create pressure on UC to accept a deal that doesn’t cover the costs of inflation that we are all seeing across the board.

This action with HMO patients impacts about 4,700 UC Davis Health patients. The Feb. 29 contract termination will affect thousands more. If you have additional patient inquiries or patients who need information to help complete the Continuity of Care form, these patients can be directed to our patient assistance phone line at 1-800-2-UC-DAVIS.

We appreciate your support and understanding as we work to resolve this situation with this difficult health plan. We are committed to ensuring no patients delay life-saving care while a profit-driven corporate giant plays with patients’ health as a chip in their profit-seeking plans.