Anthem Blue Cross & Blue Shield/Wellpoint

2015 Staples Mill Road
PO Box 27401
Richmond, VA 23230
Member Services: (800) 451-1527/(804)678-1000
Provider Services:  (804) 342-0010
Web site: www.anthem.com

Key Staff
Pres., Anthem Blue Cross & Blue Shield Virginia: C. Burke King
Pres., Anthem HealthKeepers Plus (VA Medicaid Plan):Patrick Sturdivant
Medical Director: Maureen Dempsey, MD, RVP Sr. Clinical Officer
Director of Provider Relations: John B. Syer, RVP of Provider Engagement & Contracting
Government Relations: Lindsay Berry, Sr. Dir., Virginia Government Relations

Other Contacts
General Company Information: Scott Golden, Public Relations Dir.
Grievance/Appeals Procedures: Kimberly Stevens, Process Improvement Consultant, Grievances & Appeals
Quality Improvement: April Swineford, Accreditation Manager
Pharmacy Benefits: David Morris, Pharmacist Program Manager

Specialized Health Care Services
Service In-House Contracted
Mental Health X
Pharmacy Benefit Mgmt.  X -Express Scripts PBM
Vision Care X
Dental Care X
Disease Mgmt. X
Utilization Mgmt. X

 

Market Segment
Market Segment HMO/POS PPO                 Medicare Advantage
Individual X X X
Small Group (2-49 Employees) X X
Large Group (50+ Employees) X X X,min. 35
Administrative Services Only (ASO)  X X X, min. 10,000

 

 

Network Providers (numbers are combined HMO/PPO)
Network Providers HMO PPO  PAR
PCPs Under Contract 4674 6387 6385
Physician Specialists Under Contract 8775 9196 9196
Hospitals Under Contract 92 93 93
OB/GYN’s 956 988 986

 

 

Total Enrollment (as of January 31, 2017): 2,527,857
Standard HMO 542,418
Medicaid MCO 304,330
Point-of-Service (POS) 104,271
FAMIS (SCHIP) MCO Included in Medicaid above
PPO 1,409,625
Medicare Advantage PPO 2780
Indemnity 164,433

 

Virginia HMO Services Area:

HealthKeepers, Inc. HMO Service Area:

Counties: Accomack, Albemarle, Alleghany, Amelia, Amherst, Appomatox, Augusta, Bath, Bedford, Bland, Botetourt, Brunswick, Buchanan, Buckingham, Campbell, Caroline, Carroll, Charles City, Charlotte, Chesterfield, Clarke, Craig, Culpeper, Cumberland, Dickenson, Dinwiddie, Essex, Fairfax, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Grayson, Greene, Greensville, Halifax, Hanover, Henrico, Henry, Highland, Isle of Wight, James City, King and Queen, King George, King William, Lancaster, Lee, Loudoun, Louisa, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Rappahannock, Richmond, Roanoke, Rockbridge, Rockingham, Russell, Scott, Shenandoah, Smyth, Southhampton, Spotsylvania, Stafford, Surry, Sussex, Tazewell, Warren, Washington, Westmoreland, Wise, Wythe, and York.

Cities: Alexandria, Arlington, Bristol, Charlottesville, Chesapeake, Danville, Fairfax, Falls Church, Fredericksburg, Hampton, Harrisonburg, Lynchburg, Manassas, Martinsville, Newport News, Norfolk, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, Staunton, Suffolk, Virginia Beach, Williamsburg, and Winchester

HealthKeepers, Inc. Medicaid HMO Service Area:

Central Virginia: Amelia, Brunswick, Caroline, Charles City, Chesterfield, Cumberland, Dinwiddie, Goochland, Greensville, Halifax, Hanover, Henrico, King George, Lancaster, Lunenburg, Mecklenburg, New Kent, Nottoway, Powhatan, Prince Edward, Prince George, Spotsylvania, Stafford, Sussex, Westmoreland, Colonial Heights, Emporia, Fredericksburg, Hopewell, Petersburg, Richmond City

Northern Virginia: Arlington, Culpeper, Fairfax County, Fauquier, Loudoun, Prince William, Alexandria, Fairfax City, Falls Church, City of Manassas, Manassas Park

Winchester: Clarke, Frederick, Page, Rappahannock, Shenandoah, Warren, Winchester

Charlottesville: Albemarle, Augusta, Buckingham, Fluvanna, Greene, Louisa, Madison, Nelson, Orange, Rockingham, Charlottesville, Harrisburg, Staunton, Waynesboro

Peninsula Health Care, Inc. HMO Service Area:

Counties: Accomack, Albemarle, Amelia, Arlington, Bedford, Botetourt, Brunswick, Buckingham, Caroline, Charles City, Charlotte, Chesterfield, Clarke, Craig, Cumberland, Dinwiddie, Essex, Fairfax, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Greene, Greensville, Halifax, Hanover, Henrico, Isle of Wight, James City, King and Queen, King George, King William, Lancaster, Loudoun, Louisa, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Pittsylvania, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Rappahannock, Richmond, Roanoke, Rockbridge, Shenandoah, Southhampton, Spotsylvania, Stafford, Surry, Sussex, Tazewell, Warren, Westmoreland, Wythe, York

Cities: Alexandria, Bedford, Buena Vista, Charlottesville, Chesapeake, Colonial Heights, Danville, Emporia, Fairfax, Falls Church, Franklin, Fredericksburg, Hampton, Hopewell, Lexington, Manassas, Manassas Park, Newport News, Norfolk, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, South Boston, Suffolk, Virginia Beach, Williamsburg, Winchester

Peninsula Health Care, Inc. Medicaid HMO Service Area:

Counties: Essex, Gloucester, Isle of Wight, James City County, King and Queen, King William, Mathews, Middlesex, Northumberland, Richmond County, Surry, York

Cities: Hampton, Newport News, Poquoson, Williamsburg

Priority Health Care, Inc. HMO Service Area:

Counties:Accomack, Albemarle, Amelia, Arlington, Bedford, Botetourt, Brunswick, Buckingham, Caroline, Charles City, Charlotte, Chesterfield, Clarke, Craig, Cumberland, Dinwiddie, Essex, Fairfax, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Greene, Greensville, Halifax, Hanover, Henrico, Isle of Wight, James City, King and Queen, King George, King William, Lancaster, Loudoun, Louisa, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Pittsylvania, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Rappahannock, Richmond, Roanoke, Rockbridge, Shenandoah, Southampton, Spotsylvania, Stafford, Surry, Sussex, Tazewell, Warren, Westmoreland, Wythe, York

Cities: Alexandria, Bedford, Buena Vista, Charlottesville, Chesapeake, Colonial Heights, Danville, Emporia, Fairfax, Falls Church, Franklin, Fredericksburg, Hampton, Hopewell, Lexington, Manassas, Manassas Park, Newport News, Norfolk, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, South Boston, Suffolk, Virginia Beach, Williamsburg, Winchester

Priority Health Care, Inc. Medicaid HMO Service Area:

Counties: Accomac, Northampton, Southampton

Cities: Chesapeake, Franklin City, Norfolk, Portsmouth, Suffolk, Virginia Beach