Update on insurance provider and Anthem negotiations

From: The Division of Human Resources

Updated Oct. 11, 2018

Schumacher Clinical Partners is working with Anthem and has provided additional guidance based on the questions from employees.

Although not in network with Anthem, physicians will accept the amount insurance pays. If Explanation of Benefits (EOB) show non-allowed or non-approved amounts, emergency physicians will accept the amount insurance pays and will only bill for the co-insurance and deductible amounts.

For more information on how Schumacher Clinical Partners is working with Anthem, click here.

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Published Oct. 9, 2018

Two physicians’ groups no longer in operation at Lewis Gale facilities

Anthem received notification that Roanoke Physician Services LLC (an emergency medicine physicians’ group) and Commonwealth Hospitalist Group LLC (a physicians’ group focusing primarily on the comprehensive medical care of hospitalized patients) are no longer in operation and ceased providing emergency medicine and comprehensive medical care services at Lewis Gale facilities in southwest Virginia. As a result, Roanoke Physician Services and Commonwealth Hospitalist Group no longer participate in their provider networks effective July 3, 2018. The Lewis Gale locations are Salem [hospital medical center and free-standing emergency room (ER)], Montgomery, Pulaski, and Alleghany.

Schumacher Clinical Partners now owns and manages the following ER and inpatient hospital physician groups serving Lewis Gale facilities:

ER Groups managed by Schumacher

  • Mill Mountain Emergency Group, LLC
  • Ingleside Emergency Group, LLC
  • Wildwood Emergency Group, LLC
  • Kingsford Emergency Group, LLC
  • Lake Spring Emergency Group, LLC

Inpatient Hospital Physician Groups managed by Schumacher

  • Ingleside Physician Services, LLC
  • Wildwood Physician Services, LLC
  • Kingsford Physician Services, LLC
  • Lake Spring Physician Services, LLC

The ER and inpatient hospital physician groups listed above remain out-of-network providers for Anthem’s professional provider networks. While Anthem has had contract discussion with Schumacher Clinical Partners to obtain network participation agreements, it has not been successful in reaching an agreement. Schumacher has agreed to not balance bill members and accept the amount Anthem pays the member as payment in full plus any copays, coinsurance, and/or deductible amounts due from the member. However, since they are out-of-network, this practice could change at any time.

Please see the attached list of alternate in-network providers. More information is provided on Anthem’s site.

Questions can be directed to the Human Resources Service Center at 540-231-9331.