Mercy Health, Anthem Medicaid extension to run for 30 days instead of 90
An extension for Ohio Medicaid members to continue using Anthem Blue Cross Blue Shield at Bon Secours Mercy Health hospitals under an expired contract will run through the end of the July instead of for 90 days, as initially announced.
The extension allows patients who use Medicaid, a state- and federally-funded health insurance program for vulnerable populations, to continue to receive care without disruption until July 31, even though a contract between Anthem and Mercy Health expired at the beginning of the month. On Monday, Anthem announced an "understanding" between the two would run for 90 days, but the extension has since been set to run for 30 days.
"Mercy Health informed Anthem late yesterday that it has chosen to accept standard out-of-network reimbursement for only 30 days rather than the 90 days previously discussed," Anthem spokesman Jeff Blunt wrote in a statement Tuesday. "This means that until Aug. 1, continuing care at Mercy Health requires no special out-of-network authorization beyond typical prior-authorization requirements. On Aug. 1 and after, most Anthem Medicaid members will need to transfer care to an alternative in-network care provider."
Lisa Dyson, a spokeswoman for Mercy Health, said the health system notified state officials Monday it would continue seeing Anthem Medicaid patients through July 31 "to give patients enough time to switch plans to retain long term-access" and added that it "did not commit to another specific length of time or end date." Patients will continue to have access at all Mercy Health hospitals when emergency treatment is required "regardless of the network status with Anthem," Dyson said in a statement.
"Despite months of ongoing negotiations, Mercy Health has been unable to reach a fair agreement with Anthem," Dyson wrote. "As a result, effective July 1, our Mercy Health providers and facilities are now considered out-of-network for patients with Anthem Ohio Managed Medicaid insurance. ... We want to continue negotiating to ensure access to care is available when you need it at a Mercy Health location that is convenient for you, and we encourage Anthem to do what is right for its Ohio Managed Medicaid members today and in the future."
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.
More negotiations on the horizon
While the expiration affects nearly 40,000 Ohioans who receive Medicaid through Anthem at Mercy Health hospitals, contentious negotiations between the two could affect thousands more who use another insurance product. The contract termination between Mercy Health and Anthem also extends to Anthem's Medicare Advantage which will now expire Oct. 1 if a renewal isn't agreed upon.
If Anthem and Mercy Health don't come to an agreement before then, another 20,000 Ohioans' Medicare package would become out-of-network at Mercy Health hospitals in Ohio.
"We remain committed to working toward reaching an agreement that avoids further care disruption for these vulnerable populations," Blunt said in a statement.
This article originally appeared on Cincinnati Enquirer: Ohio Medicaid members covered by Anthem at Mercy hospitals for 30 days
