Update: Anthem and MU Health Care Finalize Agreement, Provide Details on Retroactive Coverage

We were informed that the agreement between Anthem and MU Health Care was finalized, including the details about Anthem coverage being retroactive back to April 1, 2025. Please see the details below about the retroactive coverage and the process for claims:

Retroactive claims and reimbursement:

• The agreement with MU Health Care is effective back to April 1. Eligible claims for services at MU Health Care on or after April 1, 2025, will be reprocessed as in-network.
• Members may be eligible for reimbursement if they paid out-of-pocket costs to an MU Health Care provider from April 1 through July 31, 2025.
  • Please keep all receipts, billing statements, and explanations of benefits (EOBs) that you received either from Anthem or MU Health Care.
  • If you paid out-of-pocket expenses, please contact MU Health Care for assistance in obtaining a refund. MU Health Care will need to refund your payment less the in-network cost share and send that claim to Anthem for reprocessing. You will receive a new EOB once that claim has been reprocessed for your records.
• Members that received a check for claims payment
  • If you received a check and did not cash the check, please do not cash any reimbursement checks you may have received. Anthem will place a stop payment on that check. The claims related to that check will be refiled by MU Health Care and paid directly by Anthem. If you have not yet paid your in-network cost share, you will need to pay that to MU Health Care.
  • If you received a check, cashed it, and paid MU Health Care, MU Health Care and Anthem will reprocess the claim and any payment that you made for the out-of-network care will be refunded by MU Health Care.
  • If you received a check, cashed it, and have not yet paid MU Health Care, please call the number on your ID card to receive additional instructions for how to proceed.
  • Anthem will be calling members that received a check at the number we have on file for the member who received services. If you do not have a phone number included in your profile or need to update the number, you can do so on the Sydney℠ Health app or call the Member Services number on your ID card.

Cost sharing and benefits:

• Reprocessed claims will be reflected in a new EOB with in-network cost shares.
• Year-to-date deductibles and out-of-pocket maximums will be recalculated accordingly.