Update for our Anthem Blue Cross of California patients

As of March 17th, Anthem Blue Cross no longer considers Carbon Health to be an in-network provider in California.  We are very sorry that Anthem's decision to not revisit the terms of our contract has caused disruption to patient care, and we'd like to provide an update. 

We have been in discussions with Anthem Blue Cross since January 2022 to negotiate a livable wage and reduce the administrative burden for the services our care teams work hard to provide.  With unprecedented labor shortages and increasing costs to operate our service, the rate that Anthem has paid us since 2013 is no longer tenable as a livable wage.  Even a meaningful increase to our reimbursement rates would not have brought us anywhere close to what Anthem currently pays other urgent care and primary care providers in California.

Before our contract with Anthem terminated in March, we attempted to resolve our dispute multiple times with Anthem to no avail and no meaningful response. Since we went out-of-network in March, several thousands of our Anthem patients have continued to choose Carbon Health because they value and rely on the high-quality access that our clinics provide in times of urgent need.  Many Anthem patients have come to Carbon Health in the last month because they are trying to avoid costly emergency room visits, despite not having Carbon Health as an in-network choice.    

We followed our standard practice and submitted Anthem member claims for out-of-network processing, and Anthem has unexpectedly denied every single claim and has so far refused to reimburse us for this care.  It now appears that Anthem has stopped processing thousands of claims that we have submitted on behalf of our patients.  As a result, some Anthem patients have been charged out of pocket for these unreimbursed bills.

At Carbon Health, we believe everyone deserves good health – and as of today, we are taking the following steps to alleviate the burden on our Anthem patients:

• We will retroactively submit claims that Anthem has denied in hopes that Anthem will reconsider reimbursing patients based on their out-of-network benefit
• We will reduce or reimburse the difference for patients who have already been charged after we submit these claims and receive reimbursement from Anthem
• We guarantee that no Anthem patient who sought medical care at one of our California clinics will be charged more than our standard self-pay cash price in the event that Anthem chooses to deny their claim

We will process these steps in a timely manner for the thousands of Anthem patients who have visited Carbon Health since March 17th.  

We appreciate the support from our patients who have encouraged Anthem to bring us back in-network.  We will continue to submit out-of-network claims on behalf of Anthem patients who choose to come to Carbon Health for their care.  We will also work diligently to come to an agreement with Anthem as soon as possible.  

We encourage you to reach out to Anthem if you’d like to request that they process your Carbon Health claim or ask that they bring Carbon Health back in-network.  If you have any other questions, please don’t hesitate to contact us at anthempatients@carbonhealth.com

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FAQs

I have an HMO plan with Anthem with an IPA Medical Group, am I impacted?

• No, Anthem of California HMO plans are not impacted.

I have an out-of-state Blue Cross plan, am I impacted?

• Yes, if you are part of an out-of-state Anthem-provided plan, you are impacted.
• You may also be impacted if your BlueCard plan uses the Anthem network in CA.
• ~You can tell if your insurance card ID says ‘Anthem’ on it. Use the out-of-state BCBS Look-up tool.
• Blue Shield of CA patients are not impacted.

Are Carbon Health clinics outside of California impacted?

• No, we remain an in-network provider for our clinics outside of CA

I may be eligible for Continuation of Care - how does this work, and what do I need to do?

• Some patients may be eligible for a special continuation of care period. It’s typically limited to patients with chronic care needs or with special circumstances, but Anthem may make exceptions, especially for primary care patients.
• ~Guidelines can be found here.‍
• ~FORMS HERE
• Patients and providers must fill out the forms; then patients submit them to Anthem for review and decision.  It's important to know that while we’ll do our best to try and retain your care, it’s ultimately Anthem’s decision.  We’re here to help.

Anthem has stated that Carbon Health is in-network at the facility level, but providers remain out of network. Is this true?

• No, this information is incorrect. All of our CA providers and facilities have been moved out of network by Anthem. We ask that patients request that Anthem reconsider. In the interim, Anthem decides on the level of out-of-network coverage for the patient based on their benefit and plan design, and we balance bill if limited coverage has been provided.

You took my co-payment and my insurance card and didn’t inform me that you were out-of-network.

• We sent multiple notifications letting our patients know of the possibility of going out-of-network, including notices in December 2022 and February 2023.  Anthem also sent patients letters the first week of March.
• We always encourage patients to check their insurance coverage and benefits before coming in.

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