Mercy Well being threatens Anthem Medicaid contract termination

Mercy Well being threatens Anthem Medicaid contract termination

Bon Secours Mercy Well being plans to terminate a Medicaid insurance coverage contract with Anthem Blue Cross Blue Shield that covers 10,000 Ohioans until the events renegotiate a brand new contract by June 30.

The 2 firms presently have a contract that runs by way of 2024 to supply Medicaid insurance coverage to sufferers at Mercy’s 21 hospitals in Ohio. However the well being system has notified its sufferers if a brand new “honest” settlement is not made earlier than June 30, Mercy’s Ohio hospitals will not be in-network for sufferers who obtain Anthem’s Managed Medicaid the subsequent day.

A consultant for Mercy Well being declined an interview request however in a press release, the corporate cited a 6.8% enhance of working bills from 2021 to 2022 as purpose for the necessity to renegotiate a few of its contracts.

“Mercy Well being contracts with medical health insurance firms (non-public payers), similar to Elevance Well being (in any other case generally known as Anthem), to pretty reimburse the ministry for the price of offering high-quality care to our sufferers,” Mercy Well being wrote in a press release. “Sadly, Elevance Well being’s present reimbursements – that are considerably lower than different payers – haven’t saved up with inflation and are overwhelmingly insufficient to account for the price of offering secure and high quality care.”

Contentious negotiations: Hospitals and insurance companies face off in string of contract battles

On the Cincinnati-based firm’s web site, which solutions some questions in a Q&A format, Mercy stated how a lot Anthem “pays our docs, nurses and different caregivers isn’t sustainable or market aggressive,” whereas answering why a contract termination might happen.

Whereas negotiations are ongoing, Jeff Blunt, a spokesman for Anthem, stated discussions between the 2 have “stalled.”

“(Bon Secours-Mercy Well being) has notified us of its intent to not settle for Anthem Medicaid members until we conform to elevated reimbursement charges for employer-sponsored and particular person well being plans,” Blunt wrote in a press release to The Enquirer. “We have already got a contract with Bon Secours-Mercy in impact by way of 2024, which incorporates year-over-year will increase that acknowledge and handle the rising value of offering healthcare companies. It is a honest, mutually agreed upon contract that enables us to companion to fulfill the well being wants of these we serve.”

Blunt additional stated the motion from Mercy Well being would put “society’s most weak in danger with a view to leverage increased revenues.”

“If we have been to conform to their requests for increased charges, on high of will increase we’re already offering, the consequence can be increased prices borne straight by companies and people throughout Ohio,” Blunt stated.

Competition between Cincinnati hospitals, insurance coverage firms continues

The most recent rivalry follows what has develop into an rising pattern of stalled discussions and disputes between hospitals and insurance coverage firms, particularly in Cincinnati.

Within the closing hours of March, Anthem and Christ Hospital reached an agreement to maintain employer-based insurance coverage in place for 100,000 folks after months of contentious negotiations.

That adopted the same sample of stalemates that became last-minute agreements between Mercy Health and Cigna in January, and Cincinnati Children’s Hospital Medical Center and CareSource Ohio final June.

In every occasion, negotiations threaten sufferers affected to develop into out of community, inflicting a stress-filled panic relating to the place they may obtain their care if an settlement is not met.

“It’s very scary. It’s overwhelming while you’re in your 70s and you consider making an attempt to work this all out,” Sara Duffy advised The Enquirer in March, days earlier than an Eleventh-hour settlement between Christ Hospital and Anthem got here to fruition.

Mercy Well being has six hospitals within the Cincinnati market. Throughout Ohio, it additionally has hospitals in Lima, Lorain, Springfield, Toledo, and Youngstown.

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