Anthem members face bigger bills at local micro-hospitals

Tiny hospitals that are springing up around central Indiana could run into big problems with health insurers.

Anthem Blue Cross and Blue Shield, the state’s largest commercial insurer, is telling members that those small, freestanding hospitals are out of its network, a move that could drive up out-of-pocket costs and curtail use.

Anthem recently sent members a note telling them that four small hospitals in the region that have opened in the past few months are not in its network.

Micro-hospitals are set up to provide faster, more convenient service, with free parking, exam rooms just a few steps from the front door, and waiting times of 15 minutes or less to see a doctor. The facilities are often staffed with just a few doctors and nurses per shift, but charge the same rates as traditional hospitals.

Three of them that Anthem doesn't include in its network are St. Vincent “neighborhood hospitals” in Noblesville, Avon and Plainfield. Each is about 16,000 square feet, less than one-10th the size of a traditional hospital. St. Vincent is in the process of building several other neighborhood hospitals in Castleton, Brownsburg, Noblesville and Greenwood.

Also on Anthem’s out-of-network list is Hendricks Regional Health’s newest hospital in Brownsburg, a two-story, 100,000-square foot building that offers a combination of emergency care and immediate care, side by side.

Designating a hospital as out of network means that patients are likely to pay more for visits.

“While we continue to talk with these facilities about their future participation in our network, we want you and your clients to be aware so that they may choose the most cost-effective setting for their health care needs to help keep out-of-pocket costs to a minimum,” Anthem’s notice said.

A network is a group of hospitals, doctors, laboratories and other providers who enter a contract with an insurer, with agreed-upon payment rates.

“If they don’t have a contract with us, they’re outside of our network,” according to an FAQ page on Anthem’s website. “If you get treatment from a provider outside the network, you could have to pay more. Check your plan document (your contract, Evidence of Coverage, Summary of Benefits, Certificate of Coverage, or Member Handbook, etc.) for details.”

Anthem does include most major health systems in its networks, including St. Vincent and Hendricks Regional Health, but not for its small hospitals. All of the large, traditional hospitals in the Indianapolis metropolitan area are in Anthem’s provider network.

Anthem did not say why it doesn’t include the small hospitals in its network, other than to say it is still in talks with the health systems.

In response to questions, Anthem spokesman Tony Felts responded by email: “Anthem Blue Cross and Blue Shield strives to make health care simpler, more affordable and more accessible, and one of the ways to help achieve that goal is to encourage consumers to receive care in the most appropriate setting. We believe our existing network offers many choices for affordable medical care, including physician practices, retail clinics, urgent care centers and all of the area’s major hospitals.”

St. Vincent said said it continues "to work collaboratively with Anthem to help make accessing care at our St. Vincent Neighborhood Hospitals simple and affordable for its members. If Anthem members have received a bill  from St. Vincent Neighborhood Hospitals and have additional questions, they may call 1-844-285-1005 for more information."

Hendricks Regional Health said it is still in talks with the insurer to get its small Brownsburg hospital in Anthem’s provider network. The hospital, with six overnight beds, opened in January.

“I think we and Anthem will get to an agreement eventually,” said Gary Everling, Hendricks Regional’s vice president and chief strategy officer. “We’ve met several times over the last several months. We have some difference of opinion on what this facility is.”

Hendricks Regional considers the Brownsburg hospital a “full-functioning hospital” for the community, not a micro-hospital, Everling said.

Patients who enter through the Brownsburg hospital's main lobby can get a quick assessment, then a staff member will recommend the emergency room to the left or the lower-cost immediate-care center to the right. Everling said the health system deliberately designed a hospital like that to try to keep costs down for patients and insurers, so that only the most serious cases would get treatment in the emergency room.

Emergency rooms generally charge thousands of dollars for a visit, while immediate-care centers often charge only hundreds of dollars for a similar visit.