Latest news with #AnthemBlueCross
Business Wire
4 days ago
- Business
- Business Wire
Anthem Blue Cross Commercial and Exchange Health Plans Awarded NCQA Health Equity Accreditation in California
WOODLAND HILLS, Calif.--(BUSINESS WIRE)--Anthem Blue Cross is pleased to announce its Commercial and Covered California (Exchange) health plans in California have been awarded full Health Equity Accreditation by the National Committee for Quality Assurance (NCQA) through July 28, 2028. This nationally recognized accreditation is granted to organizations demonstrating leadership in closing health outcome gaps and providing culturally and linguistically appropriate services that promote equitable care across diverse populations. 'We are deeply grateful to NCQA for this accreditation—it's a powerful affirmation of our unwavering commitment to delivering high-quality, whole-person care to our California health plan members,' said Beth Andersen, President, Anthem Blue Cross Commercial Health Plans. 'This recognition underscores our dedication to meeting the needs of every member and driving fair and inclusive healthcare for every community across the state.' The accreditation applies to the following Anthem Blue Cross product lines in California: Commercial HMO/POS (Combined) Commercial PPO/EPO (Combined) Covered California Exchange EPO Covered California Exchange HMO NCQA's Health Equity Accreditation provides a trusted benchmark for consumers, regulators, and purchasers, identifying organizations that meet rigorous standards in addressing the needs of varied communities. Key components of the accreditation standards include: Fostering an internal culture that supports external efforts focused on improving access to care and wellbeing for every community. Collecting and using data to improve language services and provider network accessibility. Identifying and acting on opportunities to improve care quality for all populations and close health outcome gaps. 'Earning Health Equity Accreditation shows that an organization is making a breakthrough in providing excellent health care to all populations. I congratulate any organization that achieves this level of distinction,' said NCQA President Margaret E. O'Kane. 'Eliminating disparities in health care is essential to improving the quality of care overall.' This latest accreditation builds upon our commitment to improving health outcomes as Anthem's California Medi-Cal plan received NCQA's Health Equity Accreditation and Health Equity PLUS Accreditation in 2022 and 2023, respectively. With this achievement, all Anthem health plans in California—across Commercial, Medi-Cal, and Medicare lines of business—now hold NCQA Health Equity Accreditation. About Anthem Blue Cross As a long-time trusted health partner, Anthem Blue Cross has been providing high-quality, affordable health care for Californians for more than 86 years. Anthem Blue Cross is the trade name of Blue Cross of California. ANTHEM is a registered trademark of Elevance Health, Inc. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. To learn more, visit Also, follow us on LinkedIn, X or Facebook.
Business Wire
5 days ago
- Health
- Business Wire
Southwell and Anthem Blue Cross and Blue Shield of Georgia Announce Agreement to Expand Pathway Network Coverage in South-Central Georgia
TIFTON, Ga.--(BUSINESS WIRE)--In a great step forward for affordable access to care across South-Central Georgia, Anthem Blue Cross and Blue Shield of Georgia (Anthem) and Southwell today announced a joint agreement to include all Southwell facilities in Anthem's Pathway Network. This includes Southwell's two hospitals, Tift Regional Medical Center (TRMC) in Tifton, and Southwell Medical in Adel, as well as Southwell's physician practices and outpatient centers located throughout the region. Having these Southwell facilities in the Pathway Network provides immediate in-network access to Anthem members enrolled in ACA Marketplace plans, helping ensure cost-effective, coordinated care for thousands of residents. 'We are committed to expanding access to quality care across Georgia,' said Robert Bunch, Plan President of Anthem Blue Cross and Blue Shield of Georgia. 'This partnership with Southwell means our members in South-Central Georgia can now receive care closer to home and at a lower cost—while benefiting from the trusted expertise of a leading local health system.' Christopher Dorman, President and Chief Executive Officer of Southwell, emphasized the significance of the agreement. 'Joining Anthem's Pathway Network aligns with our mission to improve health outcomes for the communities we serve,' said Dorman. 'We are excited to offer enhanced access and affordability to patients throughout our 12-county service area.' The agreement benefits Anthem Pathway members who live in the following counties: Tift County Cook County Irwin County Ben Hill County Berrien County Plus surrounding rural counties in South-Central Georgia Members will enjoy the benefits of in-network care, including predictable costs, simplified referrals, and coordinated access to specialists and hospital services. Anthem's Pathway Network serves individuals and families enrolled through the ACA Marketplace, offering affordable options with comprehensive benefits. This new relationship with Southwell allows members to access care from a trusted regional healthcare provider without traveling long distances or facing out-of-network expenses. About Southwell Southwell is a leading integrated healthcare system dedicated to delivering quality and compassionate care in South Georgia. Southwell includes Tift Regional Medical Center, Southwell Medical, Southwell Health and Rehabilitation, and more than thirty-five (35) outpatient diagnostic and treatment facilities, physician clinics, and endoscopy procedure centers. Please visit for more information. About Anthem Blue Cross and Blue Shield Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield Health Care Plan of Georgia, Inc., an independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Additional information about Anthem Blue Cross and Blue Shield is available at Also, follow us at @anthemBCBS on X or on LinkedIn.
Business Wire
05-08-2025
- Health
- Business Wire
Michelle Stoughton Named President of Anthem Blue Cross and Blue Shield Medicaid in Ohio
COLUMBUS, Ohio--(BUSINESS WIRE)--Anthem Blue Cross and Blue Shield (Anthem), a leading provider of health benefits for Ohio residents enrolled in the state's Medicaid managed care program, announced today that Michelle Stoughton has been named president of its Medicaid health plan. 'Michelle is a highly respected leader with extensive experience in healthcare policy and government,' said Jennie Reynolds, east region president of Anthem Medicaid. 'Her proven track record in Ohio and her dedication to community health make her exceptionally well-suited to lead our Medicaid operations in the state. We are confident in Michelle's ability to drive innovation, foster strong partnerships, and improve the whole health of the Ohioans we serve.' In her new role, Stoughton assumes responsibility for all aspects of Anthem's Medicaid health plan operations in Ohio, ensuring its more than 200,000 members receive access to innovative, high-quality healthcare and support services. She will also lead efforts to strengthen relationships in the community with state leaders, providers, and other key stakeholders. Starting in 2026, Anthem will be one of four managed care organizations to provide services to Ohioans who are dually eligible for both Medicare and Medicaid healthcare coverage under its Next Generation MyCare Ohio program, in addition to continuing to provide benefits through the managed care program. 'Anthem's long-standing commitment to improving the health of Ohio communities is one I deeply share, and I'm honored to take on this leadership role,' said Stoughton. 'I look forward to working alongside our state partners, providers, members, and local organizations to strengthen access to high-quality care—both today and as we prepare to support some of Ohio's most vulnerable individuals in the Next Generation MyCare Ohio program beginning in 2026. Together, we'll continue to serve with compassion, elevate health outcomes, and make a meaningful impact in the lives of Ohioans across the state.' Stoughton brings nearly 15 years of experience in healthcare policy to her new role. She most recently served as the regional vice president of government relations for Anthem in Ohio and managed the central region team of senior government relations directors for Anthem's parent company. Before that, Stoughton served as the Midwest director for Albers & Company and as government relations director for the Ohio Council of Retail Merchants. She has also served as a legislative aide in the Ohio House of Representatives. Stoughton holds a bachelor's degree from Miami University and a Master of Public Administration from The Ohio State University. She volunteers as coordinator of All Saints Episcopal Church's In the Garden Program, a meal service for homeless individuals in downtown Columbus. About Anthem Blue Cross and Blue Shield in Ohio Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company, an independent licensee of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Ohio is available at Also, follow us on LinkedIn, Facebook, and X at @AnthemBCBS.
Yahoo
11-06-2025
- Business
- Yahoo
State Treasurer announces partnership between Hoosier Care and INvestABLE
FARMERSBURG, Ind. (WTWO/WAWV)— Indiana's State Treasurer Daniel Elliot announced a new incentive for residents who are covered by Anthem Blue Cross and Blue Shield's Hoosier Care Connect program. Those Hoosiers covered by the program who also have an INvestABLE Indiana account will have their Indiana Value Added Benefit raised to $75, effective immediately. This covers any Hoosier Care Connect members who have made their INvestABLE account within the last year. 'I'm excited to see Anthem stepping up to support Hoosiers with disabilities through INvestABLE Indiana,' said Treasurer Daniel Elliott. 'This partnership is about real people getting real tools to build a better future. ABLE accounts give folks the chance to save, plan, and live more independently—and that's something worth celebrating.' INvestABLE Indiana is a way for Hoosiers with disabilities to save and invest money without losing benefits like SSI and Medicaid. The organization offers eight savings and investment options, as well as a checking account option with a debit card. You can save up to $19,000 yearly in an account with a maximum balance of $450,000. Hoosiers with SSI can save up to $100,000 a year. Money can be withdrawn from the account for qualified expenses, or you can choose to grow it with tax-free earnings. 'At Anthem, we believe every individual deserves the opportunity to build greater independence and financial security,' said Lynn Scott, Anthem Blue Cross and Blue Shield of Indiana's Medicaid President. 'By increasing this incentive, we're reinforcing our commitment to Hoosier Care Connect members and supporting them in taking meaningful steps toward long-term stability and empowerment.' To learn more about INvestABLE or open an account, you can click this link. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
05-06-2025
- Health
- Yahoo
‘Ghost networks' are harming patients, but attempts to eliminate them have fallen short
The clock started ticking when Michelle Mazzola's son, Guy, was diagnosed with autism before his second birthday. Doctors told her the sooner Guy received therapy for his nonverbal communication and behavioral challenges, the better chance he had of reaching his full potential — and perhaps entering a kindergarten with neurotypical students. Like many parents, Mazzola hoped to find therapists who were covered by their insurance. So she consulted a directory of providers listed as 'in-network' on her insurance company's website. Mazzola spent two weeks calling providers on the list, but found no viable options. 'Probably 50% of the time no one answered the phone or the phone number was wrong,' she said. 'Then you would get people on the phone and they'd say, 'Yeah, we have about a nine-month wait list.'' Watch NBC Nightly News with Tom Llamas tonight at 6:30 p.m. ET/5:30 p.m. CT for more. She had stumbled upon what's informally known as a 'ghost network' — a directory of providers that are largely unreachable, out of network or don't accept new patients. Studies suggest it's common to encounter these networks while looking for covered care. By prolonging the search for a provider, ghost networks can delay patients' ability to get diagnosed and treated, or cause them to forgo care altogether. But regulatory efforts to force insurance companies to update their directories or penalize them for inaccurate provider information have fallen short, prompting some patients to turn to the courts. A class action lawsuit filed last year on behalf of federal employees in New York against Anthem Blue Cross and Blue Shield claims the company's ghost networks amount to deceptive advertising by making people think they're purchasing insurance with an extensive list of in-network providers. The suit further claims that inaccurate directories help insurance companies 'evade the costs' of covering people's care. It alleges that plaintiffs who could not rely on Anthem's directory were forced to use out-of-network doctors, saddling them with thousands of dollars in extra costs. In moving to dismiss the case, Anthem has argued that federal law pre-empts the plaintiffs from suing as members of the Federal Employees Health Benefits Program. Mazzola, who lives in Connecticut and runs a construction company with her husband, is not a plaintiff in the suit. She estimated that she pays about $7,000 out of pocket each month for Guy's care, even after appealing denied claims and getting reimbursed for some out-of-network costs. She believes she wouldn't have to pay that sum if the providers in Anthem's directory were available. 'You take it at face value when you're buying a plan that this is what I'm getting,' Mazzola said. 'I would have gladly gone to any of those [in-network] providers if they actually were taking patients.' If you are dealing with bills that seem to be out of line or a denial of coverage, care or repairs, whether for health, home or auto, please email us at Costofdenial@ A spokesperson for Anthem Blue Cross and Blue Shield said the company meets access requirements outlined under state law. 'We also work hard to ensure that our provider directories are up-to-date and as accurate as possible, which requires a shared commitment from providers to update their information when there are any changes,' the spokesperson said. Anthem said its provider network offers most of the services Guy needs, but due to the specialized nature of those services, it can be challenging to get appointments immediately. The company said it reviewed the list of providers that Mazzola tried to contact and found five errors related to incorrect phone numbers or addresses, which it said it will work with providers to fix. NBC News reached out to 21 providers listed in Anthem's network, and found 20 either didn't take patients Guy's age or had no availability for months. Another class action lawsuit filed in April on behalf of state and local employees in New York against Carelon Behavioral Health, which provides health care services through insurance plans, claims that ghost networks delayed plaintiffs' access to mental health treatment. Carelon said it does not comment on pending litigation. The two class action suits are among the first to challenge insurance companies over ghost networks, said Steve Cohen, a lawyer at Pollock Cohen in New York who is representing the plaintiffs in both cases as well as Mazzola. 'Patients are in need of help,' Cohen said. 'They call provider after provider who are listed in this directory to get no answer, to be told it's not a doctor's office, to be told they don't accept the insurance. It's incredibly frustrating and often complicates getting medical care. It's dangerous.' Mazzola's experience is familiar to many, regardless of their insurance plan or health issue. 'The vast majority of the time, a doctor's information is not going to be correct,' said Dr. Neel Butala, an assistant professor of medicine at the University of Colorado School of Medicine who co-founded a company that uses artificial intelligence to help large health plans improve provider data. Butala reviewed physician directories from five large health insurers and found that 81% of entries had inconsistencies, such as address errors or the wrong specialty being listed for a physician. His findings were published in JAMA Network Open. A government review of Medicare Advantage plans found that the share of inaccurately listed provider locations ranged from nearly 5% to 93%, depending on the directory. Ghost networks can pose a particular challenge to finding mental health providers, many of whom have long patient waitlists or have stopped taking insurance. After calling nearly 400 listed numbers for mental health providers in New York, the state attorney general's office found that 86% were ghost entries. Staffers on the Senate Finance Committee similarly contacted 120 mental health providers listed as in-network by Medicare Advantage plans, and found that ghost entries made up more than 80%. 'In my view, it's a breach of contract for insurance companies to sell their plan for thousands of dollars each month while their product is unusable, unusable due to a ghost network,' Sen. Ron Wyden, D-Ore., said at a Senate hearing on mental health access in 2023. Anneliese Hanson, who was a network market manager at Cigna Behavioral Health until several years ago, said she felt pressure to make provider networks seem more robust to appeal to current or prospective members. 'If our target was to have 100 autism specialists within a certain [geographic area], we would be working towards meeting that target on paper, rather than actually checking and ensuring that there were 100 autism providers,' Hanson said. A Cigna spokesperson said the company takes rigorous measures to ensure its directory is updated and accurate, and has a dedicated team of specialists to help patients access behavioral care quickly and conveniently. In response to Hanson's comments, the spokesperson said: 'These untrue and inflammatory assertions have no basis in reality, neither back then nor today.' Cohen said that federal and state standards require insurance companies to offer an ample number of in-network health care providers within a defined distance of the patient's home. Those requirements may encourage insurers to pad their directories, he said. But Butala pushed back on that idea: 'I don't think there's any actually bad actors,' he said. 'I think everyone wants to get this right.' Butala said there's an incentive for insurance companies to put out the right information, since a bad member experience could cause them to lose customers. One explanation for ghost networks, he said, is that providers report doctors' information in a way that's conducive for billing, but isn't necessarily accessible to patients. Insurers often receive data that's difficult and time-intensive to comb through, he said. 'I think it's just a really hard problem to solve,' he said. Mazzola said she and her husband, also named Guy, have been fortunate enough to afford their son's autism therapy so far. The younger Guy, now 2, is not speaking yet but has gotten better at making eye contact and using sign language to communicate words. But the Mazzolas still feel the insurance system didn't work for them as promised. 'You pay for insurance your whole life, hoping [a diagnosis] never happens, but when it does, that you can put your head on the pillow at night knowing they're going to be there for you. And that just wasn't the case,' Guy Mazzola said. Legal and medical experts say some protections against ghost networks exist, but aren't consistently enforced. Under the No Surprises Act, a federal law that took effect in January 2022, private health plans are required to verify and update their provider directories at least every 90 days. If a member receives out-of-network care because the directory information was inaccurate, insurance companies must reimburse them for any costs that exceed the in-network price. Patients can also file complaints to state regulators, who have the authority to fine companies for directory errors. But a ProPublica investigation last year determined that such fines are rare. In an average year, fewer than a dozen fines are issued by insurance regulators for directory errors, the investigation found — and even then, the penalties are small. One solution that might reduce the prevalence of ghost networks is a centralized directory of providers that all health plans could refer to. But health policy experts see that as a long-term goal that would be difficult to implement. Butala said AI can help insurers scrub their directories for errors. 'I don't think health plans are skimping on throwing people at the problem,' he said. 'I think they've been throwing too many people at the problem, and now they realize maybe AI can actually make it better.' But the Mazzolas also think insurance companies should be willing to pay more providers, so it's not a challenge to offer services in-network. 'I'm not anti-business. I'm not anti-profit, but there's an ethical side of it, too,' Michelle Mazzola said. 'Something needs to be done.' This article was originally published on
