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Northside Hospital and Anthem Blue Cross Blue Shield

What You Need To Know

Is Anthem Blue Cross Blue Shield the same as Blue Cross Blue Shield of Georgia?

Yes, they are the same. Blue Cross Blue Shield of Georgia changed its name in 2019 to Anthem Blue Cross Blue Shield.

What is happening right now with Northside Hospital and Anthem Blue Cross Blue Shield?

Anthem’s decision to issue its notice of termination to the Northside Hospital System impacts all five Northside hospitals -- Atlanta, Cherokee, Duluth, Forsyth and Gwinnett -- and more than 1,000 affiliated network providers, as well as all surgery centers, imaging locations and urgent care centers.

While Anthem has expressed a desire to renegotiate the agreements with Northside, Anthem’s notice states that the agreements for all Northside entities will terminate as of January 1, 2022 if a new agreement is not reached. This means that Anthem intends for all Northside hospitals, physicians and professional providers, surgery centers, imaging locations and urgent care centers to become out of network as of January 1, 2022 -- if the agreements are not renewed prior to that date.

Why is Anthem doing this when so many patients could be affected?

Anthem’s decision will prevent more than 1 million Atlantans – and an estimated 3.2 million Georgians -- from being able to choose in-network health care with Northside Hospital or a Northside provider or outpatient imaging or urgent care location.

It is surprising to us that Anthem has taken this action, given the longstanding relationship the parties have maintained for more than 30 years. Northside is disappointed that Anthem wants to terminate our relationship while we are still battling a global pandemic -- full and reliable access to health care is more critical than ever.

Nonetheless, Northside Hospital is firmly committed to working with Anthem to find a path forward but our patients are, and will continue to be, our primary concern throughout these discussions.

Has Northside Hospital had problems with Anthem Blue Cross Blue Shield before?

Northside has enjoyed a strong working relationship with Anthem for more than 30 years. We always work collaboratively with all insurance companies. Our partnership with Anthem includes offering lower cost network products for the Healthcare Exchange – Pathway -- and their newest program, Blue Connection High Performance Network.

Just two years ago, we successfully negotiated an amendment to our contract with Anthem.

Another renewal this quickly is very unusual. That’s why this situation surprises us – particularly as we are battling a global pandemic.

My family has had serious problems during the COVID-19 pandemic. Why do we have to deal with this, too?

Anthem’s decision to issue notice of termination with Northside Hospital during a global pandemic is regrettable. It is unfortunate that you may be impacted by their decision.

Northside’s focus will remain on keeping our communities healthy and providing them with access to the best quality health care. We will do everything we can to help you and your families.

If my family and I can’t go to our preferred in-network hospitals, what options do we have for our health care?

Northside Hospital firmly believes that an unwavering focus on patients and their families must be our goal, and that it must be shared by our insurance partners. Northside will work with you every step of the way.

We know you will have lots of questions. Northside will help you navigate this situation to minimize your health care disruptions.

We have resources available to you now at northside.com. We encourage you to visit Billing and Collections, where you will find guidance and many resources. You also can email customer.service@northside.com or call 404-851-6500.

Will Northside help me and my family with financial support during this situation?

If you have health insurance with Anthem and are forced out of the Northside Hospital and professional network, we offer financial assistance for medically necessary health care services for persons who meet Northside Hospital’s Financial Assistance Program qualification guidelines. This program could assist you if you have out-of-network benefits with your plan. To learn more about Northside Hospital’s Financial Assistance Program, you can download the Northside Hospital Financial Assistance Program Policy and  Financial Assistance Application or you may contact our Financial Counseling offices to request that a copy of these documents be mailed to you. If you are an oncology patient, the Financial Assistance Application for Oncology can be found here.

If my family can’t go to Northside Hospital or see a Northside physician, who decides where we should go for our health care?

Even if you are out-of-network, you can still be treated at one of our facilities or be treated by one of our physicians – but you may have additional financial responsibility, depending on your insurance coverage. The good news is that Northside’s patient care representatives will work with you not only on the best options for your care, but also the best possible cost arrangements.

If you are concerned about the impact of Anthem’s actions on your family, please contact your employer or Anthem by calling the number on your ID card. Also, as you evaluate your open enrollment options, you may want to consider changing plans. We participate with many insurance companies that would allow you to continue to receive in-network care at our practice, or at a Northside hospital.

What if I have a procedure scheduled in January 2022 at one of Northside’s hospitals – what should I do?

Please contact Northside at customer.service@northside.com or call 404-851-6500. Our Customer Service representatives are equipped to help you make the best decisions on in-hospital care.

What if I have an appointment with my Northside physician scheduled in January 2022 – what should I do?

If you have an appointment scheduled in January, please call the physician’s office to discuss your options. Northside physicians and their staffs are among the most respected in Georgia, and they are well-equipped to help you make the best decisions about your care needs.

My partner is scheduled to deliver in mid-January 2022 at Northside Hospital. Will Anthem Blue Cross Blue Shield still cover our costs?

You may be eligible for “Continuity of Care.” This means that Anthem will consider exceptions for individuals currently undergoing active treatment for certain health conditions. You will first need to complete a form and submit it to the company. You can visit its website at https://www.anthem.com/ to get the form, or call the number on the back of your member ID card.

I’m enrolled in Anthem Blue Cross Blue Shield through my employer. Will my employer be able to help?

You should be able to work with your employee benefits team to learn more about this situation and how it specifically affects you and your family.

With the confusion about Anthem Blue Cross Blue Shield’s coverage, how do I know if my insurance will cover the cost of my procedure?

As always, Northside Hospital billing representatives will verify your insurance coverage when you pre-register for your procedure and they will inform you if there are any problems with your coverage. To pre-register, please call 404-459-1280 or fill out our pre-registration form.

And what should I do about scheduling medical appointments after January 1, 2022?

Please contact your referring physician’s office, so you can discuss your concerns. You can also call our Concierge Line at 404-303-4291.

Northside physicians and their staffs are among the most respected in Georgia, and they are well-equipped to help you make the best decisions about your care needs.

Will Northside do everything it can to keep this termination from happening?

Yes. Our patients are, and will continue to be, our primary concern – and the reason that we will continue to work towards a solution on your behalf.

Northside Hospital firmly believes that an unwavering focus on patients and their families must be our goal, and that it must be shared by our insurance partners.

We also believe that both Northside Hospital and Anthem Blue Cross Blue Shield can find a solution – as long as every discussion begins, and ends, with a commitment to ensure access to quality health care for the citizens of the Atlanta region. This is the necessary outcome.