Anthem Blue Cross and Scripps Health Contract Not Reached

Written by Admin | Jan 6, 2025 8:00:00 AM

In early November Anthem Blue Cross notified us that they were in active negotiations with Scripps Health for a 1/1/2025 contract renewal and indicated if a new agreement was not reached, they would be moving HMO members to alternative PCPs/PMGs, effective 1/1/2025. In mid-December, due to regulatory requirements, they mailed physical ID cards with the newly assigned HMO providers to those members while they continued to negotiate with Scripps. Unfortunately, Anthem Blue Cross and Scripps Health were unable to reach agreement, and the contract terminated effective 1/1/2025. Even though the contract is currently terminated, they continue to negotiate with Scripps and are committed to making sure their mutual clients and members have access to quality, affordable healthcare.

Post Termination letters will be mailed by January 6th, and will be sent to members enrolled in products (PPO/HMO/HSA) regulated by the DMHC or CDI that personally accessed or had a covered family member access Scripps Health within the last 12 months, to members authorized or scheduled for a service or procedure at Scripps Health, and to DMHC-regulated PPO members residing within a 15-mile radius of Scripps Health. They are also mailing letters to clients and brokers and to PPO physicians who maintain non-exclusive admitting privileges/affiliations at Scripps Health.

Scripps Health includes the following hospitals located in San Diego County:
•   Scripps Green Hospital
•   Scripps Memorial Hospital Encinitas
•   Scripps Memorial Hospital La Jolla
•   Scripps Mercy Hospital San Diego
•   Scripps Mercy Chula Vista

Members who were in a current course of treatment as of the contract termination date, for one of the following conditions, may be eligible to receive continuity of care/completion of covered services:

Under California Law

Under Federal Law

Are pregnant or just had your baby.
Have a maternal mental health condition that has been diagnosed by your treating care provider.
Are caring for a child up to 36 months old.
Are getting pre-approved care.
Have an acute condition or serious chronic condition.
Have a terminal illness.

In treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment in order to avoid death or permanent harm. It can also be an ongoing (chronic) illness that is life threatening or potentially disabling and requires specialized care over a long period of time.
In a hospital or other inpatient facility.
Scheduled for nonelective surgery by your current doctor, including your post-operative care for the surgery.
Pregnant.
Terminally ill.

Members can fax this form to 877-214-1781 or can also contact ABC’s Customer Service team, who will fill out the e-form on their behalf. For updates, members can call 888-486-4227.

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