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Dispute threatens higher emergency-room fees

Local residents who have health insurance through Anthem BlueCross BlueShield may be subject to out-of-pocket emergency-room fees due to an ongoing spat between the insurance provider and Shenandoah Emergency Medicine Specialists.

Anthem and SEMS, a private-practice group that provides emergency-room medical services at Augusta Health, have not reached agreement on a new contract. If agreement is not reached by May 4, Anthem BlueCross BlueShield customers would have to pay SEMS professional fees out of pocket.

A letter was sent to local industry benefit managers who have Anthem last week informing them that as of May 4 SEMS will be out of network and listing other “in network” providers in the area, said Fred Castello, the chief medical officer at Augusta Health.

Augusta Health will remain “in network” so that any surgery, lab testing, imaging studies, hospital portion of Emergency visits, etc. that patients seek here will be covered, Castello said.

“We support our Emergency Room physicians and are encouraging a fair and rapid resolution of this situation,” Castello said.

augusta free press
augusta free press