Anthem Medicaid members allotted 90 days for care at Mercy Health's Ohio hospitals

Brooks Sutherland, Cincinnati Enquirer
Updated ·2 min read
Medicaid members who use Anthem Blue Cross Blue Shield for care at Bon Secours Mercy Health hospitals in Ohio, will have a 90-day transition period in which they can continue to receive care despite an expired contract.
Medicaid members who use Anthem Blue Cross Blue Shield for care at Bon Secours Mercy Health hospitals in Ohio, will have a 90-day transition period in which they can continue to receive care despite an expired contract.

Medicaid members who use Anthem Blue Cross Blue Shield for insurance can continue to receive care at Bon Secours Mercy Health hospitals in Ohio under a 90-day transitional "understanding" between the two parties.

A terminated contract between the two expired early Saturday without renewal, but representatives from Mercy Health and Anthem both say those affected can still get care without any disruptions, for now.

Mercy Hospital in Canton is part of the Cleveland Clinic health system and isn't affiliated with Mercy Health. An auxiliary of Mercy Health owned 30% of Akron-based Summa Health until that deal ended in 2021.

"To avoid care disruption for Anthem Medicaid members in Ohio, Anthem and Mercy Health have reached an understanding to allow our Medicaid members to continue care at Mercy Health doctors and hospitals through standard out-of-network reimbursement for a transition period of no less than 90 days," Anthem spokesman Jeff Blunt wrote in an statement. "This means that continuing care at Mercy Health requires no special out-of-network authorization, beyond typical prior-authorization requirements, to ensure that this vulnerable population will have no disruption in care during Mercy’s exit from the Medicaid provider network."

Mercy Health, similarly, has insisted patients can still receive care at Ohio hospitals despite the dispute over fair reimbursement rates.

Mercy Health-Anthem dispute: Ohioans prepare to lose Anthem Medicaid at Mercy hospitals

"All patients will continue to have access to all Mercy Health hospitals in cases of emergency treatment, regardless of the network status with Anthem," the health system wrote on its website.

How Medicaid members got caught in the middle of a dispute between Mercy Health and Anthem

Citing increased labor and operating costs, Mercy Health moved to terminate a Managed Medicaid contract it had with Anthem unless the insurance company agreed to higher reimbursements Mercy deemed fair given the inflationary squeeze they've faced.

"We feel like we're being drastically underpaid for the services we're providing," Brian Gwyn, Mercy Health's Cincinnati market president, previously said. "What they're proposing is unacceptable. It's laughable to look at those numbers that they're asking for. We know that they are making a lot of money and they're not passing that through to the actual provider that's doing the work."

Anthem however, insisted Mercy Health honor a contract between the two and renegotiate when it was initially set to expire in early 2025. The company also said it wasn't willing to agree to "rates that are three times the current hospital inflation rate."

"Mercy Health is not seeking increased payment for our Medicaid members, they are terminating their contract to serve this vulnerable population in an attempt to force higher costs on our employer-based and individual plan members," Blunt said in previous statement.

The contract termination is expected to affect an estimated 40,000 patients in Ohio.

This article originally appeared on Cincinnati Enquirer: Anthem, Mercy Health agree to temporarily continue care in Ohio