HCA, ANTHEM CUT DEAL [The Free Lance-Star, Fredericksburg, Va.]

July 10--The Spotsylvania Regional Medical Center has finally joined the Anthem insurance network.

The state's newest acute-care hospital and its largest health insurance company signed an agreement yesterday afternoon. The multiyear deal is said to cover all of Anthem's HMO and PPO products and is effective immediately.

"We're delighted to join the rest of the HCA Virginia network as a contracted provider for Anthem," Tim Tobin, Spotsylvania Regional's CEO, said in a statement.

Added John Syer, vice president for Anthem Blue Cross and Blue Shield in Virginia, in a statement, "We feel everyone wins in partnerships like this -- the hospital and area physicians, Anthem and most importantly, the people of Fredericksburg."

Spotsylvania Regional opened June 7 as the region's third acute-care hospital. Yet for some area residents, the new, $175 million building in Massaponax was to be admired but not used.

Those with Anthem health insurance were hesitant to seek treatment there for fear that they might be stuck with higher, out-of-network bills. Hospital officials tried to assure those customers that that would not happen.

Tobin, the CEO, said this week that he was pleased with the hospital's early numbers, but that business probably would have been better if the hospital had opened as an Anthem provider.

"Although our volumes are strong, I do believe not having Anthem has restrained our volumes somewhat, most likely for patients who have an Anthem HMO without out-of-network benefits," he said in an e-mail.

Anthem is the state's largest health insurance company and is dominant in the Fredericksburg area as the insurer of choice for public school systems, local governments and private employers.

"We're just very thankful that now we can serve the rest of the population," said Dr. Henry Wicker, a Fredericksburg surgeon and chairman of Spotsylvania Regional's board of trustees.

Wicker said yesterday that he had several patients who had delayed or canceled surgeries at Spotsylvania because of the insurance question.

"In fact, I'm doing two patients on Monday at Mary Washington's Ambulatory Surgery Center because they had [Anthem's] Healthkeepers and were forbidden to go to Spotsylvania," he said.

Spotsylvania Regional, with 126 beds, is the newest in the HCA chain of hospitals, the nation's largest. It is one of 13 acute-care HCA hospitals in Virginia.

HCA officials began talking with Anthem two years ago, as construction was starting, about adding Spotsylvania Regional to the Anthem network. All other HCA hospitals in Virginia are Anthem providers.

The two sides could not agree on the rates that Anthem would pay when Spotsylvania Regional treated an Anthem customer.

HCA officials said last month that Anthem's offer was too low, that HCA wanted fees comparable to those that Anthem pays Mary Washington Hospital.

At the time, an Anthem representative described the disagreement differently. He said Spotsylvania Regional was requesting fees that were higher than those paid to Mary Washington.

This month, sources said that the deal was complicated by Anthem's desire to also get lower rates at other HCA hospitals.

The two sides said yesterday that they would not disclose details of the agreement.

Jim Hall: 540/374-5433

Email: [email protected]

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