As of May 1, CommonSpirit Health facilities and physicians are no longer part of Anthem’s network in Colorado.
DENVER – The health insurer Anthem Blue Cross and Blue Shield and the health care system CommonSpirit Health have been unable to agree to a new contract that would allow CommonSpirit Health facilities to continue to be part of the Anthem provider network. As of today, May 1, there is no longer a contract between these two entities, and CommonSpirit facilities and its physicians in Colorado are no longer part of Anthem’s commercial, Medicare Advantage, and self-insured health plans. However, it is the DOI’s understanding that the parties continue to negotiate to try to reach an agreement to bring CommonSpirit Health in-network.
“We urge Anthem and CommonSpirit to remain at the negotiating table and to reach a deal to bring CommonSpirit back in-network for consumers enrolled in Anthem health plans. Unfortunately, Coloradans are the ones caught in the middle when large health systems and large insurers fail to reach an agreement,” said Colorado Insurance Commissioner Michael Conway. “As Anthem and CommonSpirit continue to work towards a new agreement, they must be cognizant that increased health care costs are ultimately borne by those same consumers in increased premiums. We have all worked very hard to keep health care costs under control for the benefit of Coloradans – it is important that work continues in these negotiations.”
Because this involves a large health insurer and a large hospital system, this situation will create many questions for people with various health care needs. With that in mind, the DOI has created a list of frequently asked questions (FAQs) to help guide people through this disruption.
Colorado DOI FAQs – Anthem / CommonSpirit Health
Anthem members should also reference information that Anthem has sent or that is available through member resources such as the anthem.com website or Anthem’s “Sydney” Health App. Members can also contact Anthem through the phone number listed on the back of their insurance ID card, by calling member services at 855-837-8536, or by logging into their online account and sending a request electronically.
Anthem has a website specific to this issue – anthem.com/commonspiritco – that contains information about the specific facilities impacted along with member resources. CommonSpirit has also created a website with information for its patients who have a health plan from Anthem – mountain.commonspirit.org/anthem#_self.
Adequate Network and Access to Care
While these contract negotiations continue to take place, the DOI will work to ensure that Anthem has an adequate health care provider network. The DOI will continue to make sure that all members are able to access the care they need from in-network providers, and if that access is inadequate, that Anthem will approve those members going out-of-network at no greater cost to the member as if they went to an in-network provider.
Continuity of Care
Anthem is also providing assistance to ensure continuity of care for members in the following situations: pregnant, undergoing a course of treatment for a serious and complex medical condition, undergoing a course of inpatient care, terminally ill, scheduled to undergo nonelective surgery, or have already obtained a prior authorization for services. Members should contact Anthem to find out if they are eligible for continuity of care – contact Anthem through the phone number listed on the back of your insurance ID card, member services at 855-837-8536, or by logging into your online account and sending a request electronically.
Anyone experiencing issues with Anthem regarding any of these issues should contact the Colorado Division of Insurance Consumer Services Team – 303-894-7490 / [email protected] / doi.colorado.gov (click on “File a Complaint”).