About Amy Umble:
Amy Umble is health reporter for The Free Lance-Star

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UMW workers among those affected by Anthem-Mary Washington contract dispute

The University of Mary Washington, like many local employers, offers Anthem Blue Cross and Blue Shield health insurance to its workers. The university may be unique, however, in the number of those workers who don’t have out-of-network benefits.

Updating the Mary Washington-Anthem dispute.

The university has 1,464 people on its health plan, said Sabrina Johnson, associate vice president for human resources. Sixty-six percent of them do not have out-of-network coverage, Johnson said.

The Anthem-MWHC split will not affect all of UMW’s employees since many of them live outside the Fredericksburg area. Yet, because of the split, the university is now recommending that some employees “buy-up” to obtain the out-of-network rider, Johnson said.

“Especially as of late, we are encouraging our new employees at the time of hire to consider seriously the out-of-network option,” she said.

Out-of-network coverage has become an issue now that Mary Washington Healthcare has split from the Anthem network. Generally customers without out-of-network benefits must pay the entire cost of their care if they go to an out-of-network provider.

Mary Washington has promised Anthem patients who do have out-of-network benefits that they will face the same out-of-pocket costs that they would have faced if Mary Washington had remained in the network.

MWHC has not made that promise to patients who lack out-of-network benefits. It’s told those patients that it will work with them to get an exemption from Anthem so they can be treated at in-network rates. Anthem has said it usually doesn’t give that permission.

In a related development, the university last week reminded its workers who have out-of-network benefits what will happen if they go to one of the affected Mary Washington facilities. A memo to the staff said:

“Please be advised that MWHC will continue to submit claims to Anthem and will bill the patient directly. Because Anthem does not make direct payments to any out-of-network providers, there is a good chance that Anthem will send the payment to the policy holder to pay the bill.  In these cases, please be sure that MWHC receives the payment.”