Ambetter “In-Network” at Archbold on Federal Exchange Plan

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Patients in Archbold Medical Center’s service area with insurance coverage under plans created for the Affordable Care Act may have recently received a notice from Archbold regarding their Health Insurance Exchange plan from Anthem Blue Cross Blue Shield (BCBS) of Georgia, and the insurance provider’s decision to remove all Archbold hospital and physician providers from their list of in-network providers.

The changes affect the Anthem Pathway, Anthem Pathway X, Anthem Enhanced Pathway and Anthem Enhanced Pathway X health plans. Several other area hospitals in South Georgia were also removed from the Anthem BCBS exchange plans.

For those seeking insurance coverage on the federal healthcare marketplace exchange website, www.healthcare.gov, Ambetter Health Plan is the now the sole patient coverage option accepted for any Archbold health system facility or provider.

Effective January 1, 2021, patients who purchase Anthem Pathway coverage from the federal healthcare marketplace exchange or choose an Anthem Pathway healthcare marketplace exchange plan through a local broker will no longer be in-network when using services across the Archbold health system. The changes don’t affect State Health Benefit Plan employees who have Anthem BCBS HMO, PPO, Open Access, nor any other Anthem BCBS plan without the name “Pathway” on the card.

The open enrollment period for coverage beginning January 1, 2021, began November 1, 2020, and ends December 15, 2020. During open enrollment, those seeking coverage can visit the federal exchange website, www.healthcare.gov, to review coverage options. Ambetter Health Plan is the only plan considered in-network for all Archbold facilities and providers beginning January 1, 2021.

In addition, beginning January 1, 2021, Archbold hospitals and physicians will still treat members of the Anthem Pathway exchange plans if authorized by Anthem, but members may have a higher out-of-pocket cost when using an out-of-network provider such as Archbold. Patients continuing with Anthem Pathway exchange plan coverage after December 31, 2020 may have to pay a higher out-of-pocket cost to utilize Archbold providers.

Archbold will continue to be in-network with the Anthem Pathway health insurance exchange health plans until December 31, 2020, and all other Anthem health plans are not affected by this change.