We have learned that the contract resolution does NOT apply to 2014 and later Anthem individual and family plans with the Pathway and Pathway X PPO or EPO networks. This is officially bad news for Anthem individual clients. The Lucille Packard Children’s Hospital is included in both networks (Tier 2 hospital in the EPO).
Chris Rauber at the SF Business Times reported the news yesterday.
The new deal is retroactive to Sept. 8, “and Anthem will work with Stanford to reprocess claims for services provided during the period that the contract had lapsed,” both sides said in a joint Nov. 12 statement.
The deal is reportedly for three years and applies to individual and small business plans, as well as large group and Medicare plans.