Anthem Network Changes – UPDATE

As you may have heard in the news, two large Southern Maine practices, Coastal Women’s Healthcare and Fore River Urology recently notified patients that they have decided to withdraw from Anthem’s network, effective in late summer.

Anthem and Coastal Women’s Healthcare (CWH) notified us on June 21, 2022 that they have reached an agreement, and CWH will NOT be leaving the Anthem network.

https://www.anthem.com/press/maine/coastal-womens-healthcare-and-anthem-blue-cross-and-blue-shield-announce-new-contract/

Anthem continues to negotiate with Fore River Urology, but they have been unable to settle on a new contract.

The Health Trust is dismayed and concerned about the lack of access to these established providers.  However, we do also understand that there is a balance to be maintained in order to control the costs of healthcare.  Both organizations initially asked for very large increases (between 50 to 70%) in the amounts they are paid for services provided.

State law requires that 60 days notice be provided to members if their doctor leaves the network.  Anthem will be sending out letters to all impacted members if an agreement cannot be reached by that timeframe.

Under the Continuity of Care provisions, you may be able to stay with your current doctor(s) for a limited time if you are receiving certain types of care.

Under federal law, this includes care if you are:

  • 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.

Continuity of Care Application Form

Please contact MMEHT Member Services so that we can assist you with the Continuity of Care process, or in finding a new in-network provider if you so choose.  Member Service representatives are available Monday through Friday from 8:00 a.m. – 4:30 p.m. at 1-800-852-8300.

Anthem and Maine Medical Center Contract Information – Update

As we previously communicated, Maine Medical Center (MMC) has announced its intention to leave the Anthem network on January 1, 2023.

The dispute between the Anthem and MMC is about how the hospital is paid, and if MMC is charging appropriately for services as per their existing contractual agreement.  Anthem and MaineHealth have been working with a mediator for several months to address disagreements regarding terms of their current contract. We have spoken with leadership of both parties, and recently learned that they have resumed talking to each other, to attempt to resolve these issues, which is very encouraging.  We remain hopeful that the parties will work out their differences and that MMC will remain in the network.

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Anthem and Maine Medical Center Contract Information

As you probably have heard, Maine Medical Center (MMC) has announced its intention to leave the Anthem network on January 1, 2023. We note that MMC and Anthem have been negotiating their contract for a few months and both parties are continuing to mediate their contract concerns. Since the effective date of this change is nine months away, we remain hopeful that both parties can work out their differences and that MMC will remain in the network. We are monitoring the situation on behalf of our members and employer groups, and we are looking into contingency plans in the event an agreement cannot be reached. We will continue to be in close contact with Anthem management.

We understand the concerns raised by this announcement and this potential change. As this has just been announced, we appreciate your patience as we maneuver this evolving situation.

For the latest updates please visit:  https://www.mmeht.org/anthem-and-maine-medical-center-contract-dispute/

Forms 1095-B will be arriving soon

As required by the Affordable Care Act, the Health Trust will be sending out Forms 1095-B to all employees (including retirees and COBRA participants) who were covered under a Health Trust health plan during calendar year 2021. The 1095-B forms provide information on each individual (employee and dependents) who had health coverage through the Trust in 2021, including which months they were covered. Forms will be mailed prior to the March 2, 2022 deadline.

The 1095-B forms provide information that may assist you in preparing your taxes, however they do not need to be filed with the tax returns. The IRS has stated that taxpayers need not wait for these forms, and should file their returns as they normally would. Copies of all of the forms will be filed with the IRS by the Health Trust, through its eligibility vendor.

If you have any questions about your Form 1095-B, please contact the Billing & Enrollment staff at 1-800-452-8786, or htbilling@memun.com.

At Home COVID Test Kits

Did you know that you can submit a claim to your medical insurance for reimbursement of the purchase cost of an At Home COVID-19 test kit? Your medical insurance plan with Anthem covers for COVID testing, including home or self-administered tests. Reimbursement is limited to eight tests per covered member per month.

In order to receive reimbursement, you need to submit a claim form and a legible store receipt that shows the description of the item purchased.  The Anthem claim form can be found on our website here and it includes the mailing address for claims. You can also submit a claim form through the www.Anthem.com website or the Anthem Sydney app.

Members participating in the Retiree Group Companion Plan may also submit for reimbursement of At Home COVID-19 test kits purchased on or after January 15, 2022.

The U.S. Government is also providing four At Home COVID-19 test kits per household at no charge. You can sign up to receive these at https://www.covidtests.gov/

 

Mental Health Services via Telehealth

During the early stages of the pandemic, there was a dramatic shift to utilization of telehealth for services that would traditionally have been office visits.  Use of technology, including by smart phone, tablet, computer or telephone-only, was strongly encouraged to increase health system capacity and to limit office visits which could increase the spread of Covid-19. 

To incentivize use of telehealth, the Trust waived cost shares for these visits.  While visits to primary care physicians have been returning to more normal utilization patterns in the office, utilization of telehealth for mental health and substance abuse services continues to increase. It is well documented that the impacts of the pandemic have created an increased need for mental health care. 

In order to facilitate continued utilization of these services, the Board of Trustees has extended the cost share (copay) waiver through the end of 2022 for members who receive mental health or substance abuse services via telehealth.  The cost share waiver for other telehealth services, including for Primary Care and Specialty Care visits, expired December 31, 2021.

Health Trust Administration & Billing Updates for Employer Group Representatives

The Health Trust routinely generates the monthly billing statements on the fourth of each month, but this January’s statements will be generated on December 17. This will allow for as much maintenance as possible from Open Enrollment (Nov 15 – Dec 15) to be completed and the January billing statements to be as accurate as possible. To assist our staff, please have applications for any changes submitted as early as possible to the Health Trust by emailing them to HTbilling@memun.org. Salary changes to be effective January 1, 2022 will be accepted up to and including December 14.

See Your Health Care Information Online

You can get instant access to your health plan information at www.anthem.com or with Sydney, Anthem’s new mobile app.

Using the website or the app, you can securely check claims, locate a doctor, refill a prescription, and find many other helpful ways to manage your health care.

Your current medical ID card is also available for quick viewing right on your mobile device using the Sydney app.  This is especially helpful if you are uncertain if you have the newest version.

From your computer: Go to Anthem.com/register and set up a username and password. You will be prompted to set your email preferences and complete your registration.

From your mobile device: Download the free Sydney mobile app and select Register. You will confirm your identity and create a username and password. You will then be prompted to set your email preferences and complete your registration.

If you need help signing up for the website or mobile app, you may call Anthem Website Technical Support at 1-866-755-2680.

Informational flyer about online access

Make sure to use your new Medical ID Cards!

Old ID cards can no longer be used effective January 1, 2021.

Anthem moved to a new system to process claims effective January 1, 2021. As a result, all members who receive health coverage through the Health Trust were mailed new medical identification cards in late December or early January.  The cards look very similar to your old cards, but all members have a new ID number.

To avoid any confusion or delays in processing your claims, please be sure to destroy your old cards and use the new cards.  Also, please make sure your providers and pharmacy have the updated ID number for you and your family members.  If you present an old ID card with your previous ID number, claims may be denied or delayed.

On the new medical identification cards, all active members’ ID numbers start with a “B” on the card.  IDs for retirees who participate in the Group Companion Plan start with an “M”.  Also, an issue date will be printed in the bottom left corner on the back of the card, so you can make sure you have the most recent version.

If you have any questions about your ID cards or your health benefits, please contact the Health Trust at 1-800-852-8300.  Member Service Representatives are available to assist you Monday through Friday from 8:00 a.m. to 4:30 p.m.

New Health Care Summary to Replace EOB Forms

On January 1, 2021, Anthem will move to a new system to process medical claims. As a result of this change, members who have health insurance with the Health Trust will begin to receive a new Health Care Summary, instead of the current Explanation of Benefits (EOB) forms. These new Summaries will be in color, will include graphics, and will help members to better understand their costs and make future healthcare decisions. They will include claim details with balance/accumulator information, as well as some new enhancements such as information on savings opportunities, preventive care reminders, and health condition messages.

Each Health Care Summary includes information on all claims processed over a 14 day period of time. The subscriber (employee or retiree) will receive a consolidated Summary, showing claims for themselves and any covered dependent children under age 18. Adult dependents (spouse, domestic partner, or dependent child age 18 and over) will each receive their own Summaries.

Since the new Health Care Summaries will include claims processed over a two-week period, you may find that you are receiving fewer Health Care Summaries, compared to the Explanations of Benefits.  This will help to save on paper, and will reduce mailing costs as well.

You will also be able to view your Health Care Summaries online, at www.anthem.com. If you choose, Anthem will send an email notification to the email address noted on your online account when a new Health Care Summary is available. This way, you can log in to view your new Summaries as soon as they are available.

If you have any questions about the new Health Care Summary, please contact the Health Trust at 1-800-852-8300. Member Service Representatives are available Monday through Friday from 8:00 am – 4:30 pm. You may also reach Member Service Representatives via email, at HTMemberServices@memun.org.

 

Sample of New Anthem Health Care Summary

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