To: Bloomington-area Employees Enrolled in an IU-sponsored PPO Medical Plan
Date: November 6, 2012
Subject: Premier Healthcare & Anthem PPO Network

The university is very disappointed that Premier Healthcare has yet to rejoin the Anthem PPO network. Deciding to cease participation in this state-wide PPO network unnecessarily disrupts relationships with patients, many of which are covered by IU-sponsored medical plans. This disturbance is concerning to the university, and most importantly, concerning to individuals.

It is most unfortunate that healthcare systems and physician groups in the US negotiate with network management companies through tactics that interrupt patient care and coincide with open enrollment activity. Last year it was St. Francis Healthcare and the year before that it was St. Vincent Healthcare — both large healthcare systems rejoined the Anthem PPO network at the "11th hour." (IU employees will recall that Premier ceased participation in this PPO network in 2008 and radiologist and anesthesiologist groups did the same some years earlier. In each case, the provider group rejoined the PPO network.)

Earlier emails have detailed the difficulties in Premier's request for a considerable increase in fees. Essentially, Anthem has a state-wide physician fee schedule, which is accepted by other physicians, including IU Health Physicians.

The university remains hopeful that Premier will rejoin the Anthem PPO network. In the interim, here are some resources the university hopes will assist employees and their families:

Continuation of Care Safeguards (contract safeguards in the provider contract with Anthem)
Premier is required to honor its contract during a 60-day transition period following termination in cases where continuity of care is critical. These safeguards include ongoing care in progress at the time the contract expired.

• Members in the hospital on November 1, 2012, will have associated Premier professional services for the remainder of the inpatient stay paid at the in-network level just as if Premier were still under contract.
• Premier outpatient services that are part of an ongoing critical treatment plan started before November 1 will continue at the in-network level through the transition period. Example: a member has begun a series of oncology treatments, these treatments would continue to be covered at the in-network level.
• Life-threatening emergency services (e.g., if a Premier physician provides care for chest pain in the emergency room), are paid at the in-network benefit level and Premier may not bill for amounts above what the Anthem contract allows. The member would only be responsible for the in-network deductible (if any in the member's plan) and co-pays up to the in-network out-of-pocket maximum.
• A woman under Premier care who is in her second or third trimester of pregnancy will have any Premier professional services related to the pregnancy (e.g., gestational diabetes) paid at the in-network level through post-partum care.

Finding a PPO Provider (hospital or physician)
PPO network providers can be identified both through Anthem customer service (800-345-2460) and the Anthem web page at www.anthem.com, which contains a "Find a Doctor" feature. An IU email resource is also available by sending inquiries to .

IU Health Southern Indiana Physicians is providing a resource for employees who would like help in locating a PPO network specialist. Please contact Dan Rademacher, RN Care Manager at IU Health. He can help provide a referral connection with an alternate physician specialist in the Bloomington and Indianapolis areas. He can be reached at 812-353-3089 weekdays from 8am – 5pm.

Other details and updates will be posted at the following website: http://hr.iu.edu/benefits/premier.

Indiana University remains hopeful that Premier will rejoin the Anthem PPO network very soon.