BCBS 90 days extended coverage for Wellstar

06.02.19 02:43 AM By Peter

Benefits extended 90 days for Pathway members with WellStar PCPs

Helping to ensure members have access to health plans that offer greater affordability and access to quality health care remains our focus at Anthem Blue Cross and Blue Shield. It’s come to our attention some members may have enrolled based on the incorrect assumption WellStar would be in the Pathway network throughout 2019.  We have worked closely with Commissioner Beck and the Department of Insurance to find a solution that allows impacted Pathway Members to receive care from WellStar primary care providers beyond February 4, 2019.

We are pleased to extend benefits for 90 days to Pathway Members who, during open enrollment, selected or were assigned a WellStar affiliated primary care physician (PCP), or those who attempted to choose a WellStar PCP.  “Extension of benefits” means the impacted Anthem Pathway Member can receive treatment from WellStar PCPs until May 4, 2019, and Anthem will allow the previously contracted reimbursement rate.

We cannot guarantee that WellStar will permit Pathway Members to schedule appointments, nor can we guarantee WellStar will not bill members for the difference between the Anthem allowed reimbursement and WellStar’s billed charges (called “balance bill”).  However, we understand that WellStar committed to the Department of Insurance not to balance bill Pathway Members during this time, collecting only member cost shares that may apply.

This extension of benefits will allow Pathway Members extra time to move to in-network PCPs.  The extension of benefits does not apply to outpatient services or hospital inpatient admissions at WellStar Hospitals occurring after February 4, 2019.   Pathway Members who qualify for the 60-day continuation of care period may have other options.  Members can call the Member Services number on their Anthem ID card for more information.

To help answer our members’ questions and give guidance on how to access care from in-network providers, Anthem is mailing letters to members. This notification explains the impact on their coverage with Anthem and the health care options available to them.

Additionally, Northside Health Systems, which is in-network, has agreed to establish a hotline number, 1-404-303-4291, to provide concierge services to assist Pathway Members who need help scheduling appointments during this period of transition. We look forward to making sure our members receive high quality, affordable care through our network of participating providers and hospitals.

For the most up-to-date information, visit anthem.com/wellstar.