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Hospital warns Anthem PPO members may soon be ‘out-of-network’

Hazel Hawkins officials say insurer has ‘refused’ to pay fair rate

Representatives from Hazel Hawkins Memorial Hospital spoke at a Tele-Town Hall last Friday.

Hazel Hawkins Memorial Hospital said in a statement that a major national and regional private health insurer is “refusing” to pay the Hollister hospital a fair price for health services. As a result, after Aug. 10, patients insured by Anthem Blue Cross Preferred Provider Organization policies might find themselves “out of network” at the local hospital, says the press release from Hazel Hawkins. 

Anthem PPO is one of the largest private health insurance companies in the nation, employing more members in California than any other insurance provider, says the press release from HHMH. But in recent negotiations that have been ongoing for nearly three years, Anthem PPO has declined to “align their payment (to HHMH) with the market rate.”

As a result, Anthem Blue Cross PPO has a deadline of Aug. 10 to propose a fair payment, according to HHMH. In the meantime, the hospital has notified Anthem PPO that HHMH has terminated its contract with the insurer. 

“We began negotiating for an appropriate market rate adjustment in 2020,” said Mark Robinson, HHMH Chief Financial Officer. “HHMH, the only hospital within 25 miles, is expected to provide care for Anthem PPO members at less than market rates.”

Anthem Blue Cross has not responded to a request for comment. 

According to a 2021 Kaiser Family Foundation report, the average premiums for family insurance coverage have risen faster than inflation over the last five years, the HHMH press release adds. 

In January, HHMH officials provided Anthem with a notice of contract termination, with the hope that an appropriate rate would be offered, the hospital continued.

“Unfortunately, a termination notice is the only tool we have to get Anthem’s attention,” said Steven M. Hannah, HHMH Chief Executive Officer. “Access to quality healthcare is a right for the communities we serve, yet our organization must advocate for the financial stability of our District. Anthem, like all other commercial payers, needs to provide market competitive reimbursement for the health care services rendered by Hazel Hawkins Memorial Hospital.”

The press release continues, “Ideally, Anthem will provide an appropriate rate increase and this situation will be rectified prior to Aug. 10, 2022. If Anthem cannot reach a financially equitable agreement with HHMH by Aug. 10, 2022, HHMH will no longer be a contracted provider with Anthem Blue Cross PPO. This means the care Anthem PPO members receive from HHMH will be out-of-network on Aug. 11, 2022.”

Local Anthem PPO members who are concerned about the impact on their healthcare services at HHMH can call the hospital at 831.205.5710, the press release adds. 

“HHMH officials stand ready to negotiate in earnest or take whatever other steps are necessary to receive appropriate reimbursement for the care we provide and being back in network for Anthem Blue Cross PPO members,” says the press release from HHMH.