Anthem Network Update: Sutter Health May Terminate January 1st
Sutter Health issued a notice to terminate its contract with Anthem Blue Cross, effective January 1, 2025.
This does not impact retired members enrolled in the CompanionCare Medicare Supplement Plan.
To date, Anthem and Sutter Health have been unable to reach an agreement which means the contract may terminate effective January 1st, 2025. The contract termination would include the medical groups, physicians, and facilities.
Although contract negotiations such as this are often worked out prior to the termination date, that is not always the case. We are closely monitoring the situation and will keep you apprised of updates as they become available.
Anthem's commitment stands firm to establish a new agreement, and we remain optimistic about our shared dedication to this objective. In an event where an agreement is unfortunately not reached, Sutter doctors and facilities will be out-of-network for Anthem members effective January 1, 2025.
This could affect the out-of-pocket obligations for Anthem members who receive non-emergency care at Sutter. We can assure our members that we have a substantial network of high-quality partners throughout the State prepared to provide care for members currently under Sutter.
Yes! Members wishing to request continuity of care should contact the member services number at 800-825-5541 for further assistance. If a member began a course of treatment with Sutter Medical Groups before the contract termination date for one of the following conditions, he or she may be eligible to receive continuity of care:
- 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.
- In a hospital or other inpatient facility.
- Are getting pre-approved care.
- Scheduled for nonelective surgery by your current doctor, including your post-operative care for the surgery.
- 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.
- Have a terminal illness.
When a case is approved for continuity of care by Anthem, the claim is processed at in-network benefit levels. If a member has one of the conditions that qualify for continuity of care listed above, but Anthem does not approve the request, in-network benefit level coverage will not be provided. In this situation, the provider will be considered out-of-network and the member, if he or she chooses to receive care from the provider, may incur significant out-of-pocket expenses.
Members would still be able to utilize Sutter facilities for emergency services as emergency medical services are always considered a covered benefit no matter where the care is provided. Anyone in need of emergency care should immediately go to the nearest emergency room or call 9-1-1. Coverage will be provided according to the member’s heath care policy benefits.
Members who are seeking non-emergency care should look for services at a local in-network facility. Members can locate a participating hospital in a specific area by accessing the Find Care function at www.anthem.com/ca/sisc or by calling member services at 800-825-5541.