Insurer's actions may force critically ill kids to seek care out of area| Chief medical officer

Dr. Rustin Morse is chief medical officer at Nationwide Children’s Hospital.

Anthem Blue Cross Blue Shield of Ohio should be covering health care services for some of Ohio’s most vulnerable children – but instead, the company is limiting access to that care in central Ohio.

Patients who are now receiving care at Nationwide Children’s Hospital for cancer, heart defects and other critical conditions may be forced to travel somewhere else because Anthem chosen not to include Nationwide Children’s as an in-network provider.

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At Nationwide Children’s, we believe that no child should ever have to leave our region for care.

So as an emergency medicine physician, a parent and chief medical officer at Nationwide Children’s, I’m concerned for these children and their families.

The background

Medicaid is the government insurance program that covers people who face significant challenges, like disability or limited income — and that includes more than 1.3 million children in Ohio. Almost all receive that coverage through seven Medicaid managed care plans, some of which are new to Ohio this year.

For decades, Nationwide Children’s has maintained positive working relationships with the state’s Medicaid managed care programs.

We are now in-network with six of the seven plans.

That leaves only one: Anthem Blue Cross Blue Shield.

Despite a long period of negotiation, Anthem, a new Medicaid plan in Ohio, has refused to enter into an agreement with us that is nearly identical to agreements we have with all the other plans.

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Families may have to transfer to other hospitals.

Without in-network coverage, children who are covered by Anthem Blue Cross Blue Shield’s plan may no longer be able to receive care that is crucial to them at our hospital. Patients have been assigned to Anthem’s plan without their knowledge, or families are choosing to be covered by Anthem without understanding that the plan does not include central Ohio’s children’s hospital.

These families may have to transfer to other hospitals, making an already stressful situation for a family even worse.

What is the hospital doing about this?

Are we still providing care? Absolutely.

We continue to provide care even though we have no agreed-upon way to receive payment for those services. Nationwide Children’s remains committed to our 131-year mission of serving children regardless of a family’s ability to pay, and we are continuing to provide care to members of Anthem Blue Cross Blue Shield’s plan even though we are out of network.

We encourage families to check to see if they are enrolled in Anthem Blue Cross Blue Shield’s Medicaid plan to ensure they can receive uninterrupted care. Impacted families do have the option to change to one of the six other plans that are in network at Nationwide Children’s, but they must do so before May 1. Medicaid plans that are in-network for our hospital are:

• AmeriHealth Caritas Ohio

• Buckeye Health Plan

• CareSource Ohio

• Humana Healthy Horizons

• Molina HealthCare of Ohio

• UnitedHealthcare Community Plan of Ohio

My colleagues and I at Nationwide Children’s encourage impacted families to ask for help in ensuring coverage. Visit NationwideChildrens.org for a guide on how to enroll in a different Medicaid plan.

We also encourage Anthem to do the right thing and join their fellow plans in ensuring Ohio’s most vulnerable children have access to the services they need, in the communities where they live.

No family should have to travel hours for critical medical services when they are available right here.

Dr. Rustin Morse serves as chief medical officer at Nationwide Children’s Hospital. He is a board-certified pediatrician and board-certified pediatric emergency medicine physician.

This article originally appeared on The Columbus Dispatch: Impact of failed negotiations between Anthem and Nationwide Children's Hospital