Anthem vs. Christ Hospital: Contract dispute threatens patients' insurance coverage
Last November, Sara Duffy attended an event hosted by the National Association of Retired Federal Employees at a Kenton County library branch in Erlanger.
She listened to a presentation from a representative from Anthem Blue Cross Blue Shield, who said all her family's doctors were covered in the insurance company’s network.
After the presentation, she signed up with Anthem.
Just a few months later, however, a contract dispute between Anthem and Christ Hospital, where her husband has received cancer care for years, could push their doctors out of Anthem’s network, forcing them to find new ones.
“There was no hint from their representative of any contract dispute,” Duffy said about the Nov. 10 event she attended. “Because, of course, then we wouldn’t have gone with Blue Cross Blue Shield, we would have gone with a different company.
“It’s very scary. It’s overwhelming when you’re in your 70s and you think about trying to work this all out.”
Duffy and her husband Terry, of West Harrison, Indiana, now are among the thousands of patients caught in the middle of increasingly contentious battles between Greater Cincinnati hospitals and the insurance companies that cover their patients’ care.
Negotiations: Christ Hospital warns patients could lose Anthem coverage if contract isn't renewed
The fight between Christ Hospital and Anthem Blue Cross Blue Shield is the most heated today, but it’s not the only one that has put patients on edge recently.
Christ is the third local hospital in the past nine months to face difficult contract renewal negotiations that went into the final hours or beyond with an insurance provider.
Late last June, Cincinnati Children's Hospital Medical Center informed 1,000 Ohio marketplace members they could lose coverage at the hospital if a renewal with CareSource Ohio wasn't met. The two sides reached an agreement on July 29, just days before a contract expiration would have removed the hospital's only remaining marketplace provider.
Then, in December, after months of negotiations, Mercy Health slammed insurance provider Cigna for engaging in "bad faith" negotiations amid a looming contract expiration. The two later agreed to a renewal on Jan. 5, four days after their previous contract expired on Jan. 1.
Christ’s contract with Anthem, which involves hospitals, outpatient centers and several other facilities, expires Friday, rendering the hospital out of network on April 1. A second contract involving Christ Hospital Associates and urgent care centers expires at the end of April. The language of the current contracts allows procedures to be covered for 90 days after an expiration if a renewal isn't met, but an expiration would have serious repercussions.
If a contract isn’t renewed, more than 100,000 patients insured by Anthem Blue Cross Blue Shield would become out of network at Christ Hospital, a Christ spokesman said. That threat has unsettled thousands of patients.
David Barber, who received a ventricular assist device at Christ after he had congestive heart failure, said he’s worried about where he will continue his care should he need any further procedures or treatments. Barber has a long history of care with cardiologist Dr. Tom O’Brien and has developed a trust of Christ’s cardiology team.
“Having the option of convenience and the level of care that I know takes place here at Christ Hospital, I definitely have questions about what would happen afterwards,” he said.
How negotiations reached a stalemate?
Last month, the Christ Hospital Health Network began sending letters notifying patients of the impending expiration, warning that patients insured by Anthem at the organization’s medical centers, outpatient locations and urgent care centers could become out of network on April 1.
Christ’s position in negotiations is that it is simply asking for fair and equitable reimbursements, given the increased inflation rate, increased labor costs and insurance rates of other health organizations in the marketplace. Anthem’s offers so far have been “inadequate, barely exceeding half the inflation rate,” a spokesman said in a statement released last week.
Anthem, meanwhile, says the health organization is proposing cost increases that would be an “unacceptable financial burden for greater Cincinnati consumers and their families and for our community’s employers,” according to a special website the company created to provide updates on negotiations.
“At the heart of this negotiation is our goal to keep quality, affordable services available to our members, and to take increased financial pressure on Ohio families off the table,” an Anthem spokesman later wrote in a statement to The Enquirer.
Christ representatives have cited independent research conducted by the RAND Corporation that shows existing reimbursement rates for inpatient and outpatient services at Christ Hospital fall in the bottom one-third of health providers in the region.
Debbie Hayes, Christ’s president and chief executive officer, said hospitals around the country have faced a number of challenges in a post-pandemic world but have stepped up to meet those challenges in order to continue to provide care to sick patients.
Hayes said the inflation rate, which was about 6% in February, and labor cost increases of as much as 20% have hit hospitals hard. “All we’re really asking for is reasonable accommodations for the fact that inflation is very different than it was three or four years ago,” Hayes said.
Insurance companies see things a little differently. While hospitals have faced economic challenges during the pandemic, some recent studies show that federal assistance has largely offset operating losses specifically caused by the pandemic.
A representative from Anthem was not made available for an interview. But in a statement, a spokesman said Anthem has offered Christ Hospital “reasonable increases.”
“Businesses and families across Ohio are already impacted by high inflation, which is why we cannot concede to requests for drastic cost increases,” the statement said.
Last Friday, Christ gave an update in a news release, calling its negotiations with Anthem, “difficult.” In the update, the health organization pointed to the hospital’s efforts to take care of patients during the unprecedented pandemic and slammed Anthem for reporting a $9 billion profit over the past three years while enacting a membership increase of more than 14%.
“I think the statistics speak for themselves,” Hayes said. “I think it really gets back to, ‘What is the mission of a for-profit organization and what is the mission of a nonprofit organization?’ All of our money goes back into reinvesting in our people, in our physicians, in our platform, in our technologies to serve the community. That is not the mission of an insurance company.”
On its website, Anthem recommended members consider scheduling upcoming procedures at another health system in its network and lists TriHealth as a “preferred provider” in its network.
Hayes, however, is asking patients to keep appointments as the negotiations continue.
“We’re going to be here for them, and we’ll take care of them,” Hayes said.
A growing trend locally
In the cases of Mercy Health and Cincinnati Children’s Hospital Medical Center, deals were ultimately made at the 11th hour. Hayes said her team is working around the clock to make an agreement happen in the final hours, too.
Gerard Anderson, a health policy professor at Johns Hopkins University, said negotiations between hospitals and insurance companies have become a “common dance” even before the pandemic, dating back about 10 years or so. That dance, he said, often ends in a last-minute agreement.
“It’s no different than the U.S. Congress or the state legislature in Columbus,” Anderson said. “It is, essentially, you think you’re going to get the best deal at the last moment. I don’t think you really do. But that’s the feeling. If I hold out a little longer, I may get a slightly better deal.”
But as the sides each look to capture that best deal, thousands of patients behind the scenes are worried about what might happen to their care.
Duffy said her husband received a letter notifying him he would be covered under a 90-day continuation of care period if he bumped a planned procedure he had scheduled into June. But she suspects her husband, who receives regular checkups, will need many more appointments before the end of the year.
If Christ and Anthem don’t resolve their differences, those appointments may have to be done through a different doctor and hospital.
“This has been terrible on us,” Duffy said.
Dr. O’Brien has also been weighing how to proceed as many of his patients have come to him concerned about having to potentially switch doctors.
“The last thing they need on top of their medical problems is this anxiety over their heads,” he said. “The uncertainty is not good for anyone’s health.”
This article originally appeared on Cincinnati Enquirer: Christ Hospital and Anthem continue contract negotiations
