11 Questions: What Does Hartford HealthCare-Anthem Dispute Mean For Patients?
Here are the answers to some common questions patients might have:
What happened?
Who is affected?
Anybody who has Anthem insurance and receives treatment at any
What hospitals and facilities are included?
What about emergencies?
What if I am pregnant or undergoing treatment for an ongoing condition?
Anthem said certain customers may be eligible for "Continuation of Care" benefits, where they will continue to pay in-network rates for treatment. These benefits typically apply to cancer patients and pregnant women in their second or third trimester.
Medical conditions that normally qualify for continuation of care include:
* Patients in an inpatient setting receiving treatment for acute medical conditions;
* Patients with the diagnosis of cancer receiving surgical or radiation therapy;
* Patients with acute trauma, e.g., trauma/bone fracture care;
* Patients receiving short-term/cyclic chemotherapy;
* Patients receiving immediate post-hospital or post-surgical care;
* Patients with chronic medical conditions for which they are receiving active treatment; and
* Patients who are in their second or third trimester of pregnancy or the postpartum period.
Medical conditions that normally do not qualify for continuation of care include:
* Patients with stable chronic conditions for which there is not active treatment;
* Patients with short-term self-limiting diseases, e.g., muscle injuries, bronchitis;
* Patients scheduled for elective surgery; and
* Patients in the first trimester of pregnancy.
Customers can apply for continuation of care benefits by calling the phone number on the back of their insurance card or by visiting http://group.anthem.com/HHC
Should I reschedule elective surgeries or other procedures?
Anthem says "not necessarily," and asks customers to complete a continuation of care form first. If after a review it's determined the procedure does not qualify for continuation of care, "we'll help you find a hospital that fits your needs," Anthem says.
What about a follow-up visit for a surgery that occurred before
Routine post-surgical follow-ups will be covered as in-network if the surgery happened before
What if I was hospitalized before
All services you received will be billed as in-network if you were admitted prior to Oct.1.
What changes with billing?
Patients will receive bills directly from
What are
The two sides are continuing to negotiate, but it's not known when a new agreement will be reached. Anthem says they will help
When will an agreement be reached?
There's no telling. Three years ago, during a similar dispute,
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