Mercy Health, Anthem Medicaid release updates as insurance deadline looms today
There’s an update to the negotiations between Bon Secours Mercy Health and Elevance Health insurance company, also called Anthem.
Thousands of Mercy Health patients in the state will lose Medicaid insurance starting in July at Bon Secours as the two companies can not come to an agreement on payments.
Statement provided by representatives from Mercy Health
“Mercy Health, as part of Bon Secours Mercy Health, contracts with health insurance companies such as Elevance Health (a.k.a Anthem) to fairly reimburse the organization for the cost of providing high-quality care to patients.
Over the last nine months, we have been negotiating with Anthem to update current contracts which have not kept pace with the rising cost of labor, supplies and drugs, undermining our ability to provide care now and into the future.
Mercy Health has been unable to reach an agreement on rates. In fact, Anthem recently rescinded its most recent offer and discontinued negotiations.
This means that nearly 50,000 Ohioans (including 3,541 in Youngstown) may lose their Medicaid insurance coverage with Mercy Health beginning July 1 and may be forced by Anthem to leave doctors they know and trust.
As health care providers serving this community for more than 100 years, we find this incredibly disheartening.
Our focus is on quality, compassionate care for each person who comes through our door, and Anthem is restricting this access to care by refusing to continue negotiations.
It is critical that our patients have access to the care they need when they need it, and reimbursement to cover our costs is an important part of that equation.We want to be good stewards of your health care dollar.”
Statement provided by representative from Anthem
“Unfortunately, Bon Secours Mercy Health still plans to no longer accept Anthem Medicaid members as of Midnight tonight.
Eleventh hour agreements are not uncommon in these situations and we remain hopeful.
However, this remains a concerning situation and one that should not arise 18 months before the current contract expires.
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.
We’ve asked them repeatedly to rescind this action, honor their contract, and negotiate a new agreement at the appropriate time – when the current contract ends.
We continue to keep lines of communication open and are committed to reaching resolution as quickly as possible.”
We have set up a special website at www.anthem.com/mercyhealthohio to provide Anthem Medicaid members with information, including important information for members currently being treated at Mercy Health for serious and complex conditions on how to continue care with their current health care provider.
Statistics provided by Mercy Health:
labor costs at Mercy Health increased 9.6 percent
supply chain shortages and inflation increased operating expenses and overall cost of care by 6.8 percent from 2021 - 2022
In a recent Modern Healthcare article, it was noted that Anthem reported earnings of $2.8B in the first quarter of this year alone – a 16.6 percent year-over-year increase
Anthem earned over $2 billion while owing Mercy Health more than $100M in late and unpaid claims
Understanding next steps
Mercy Health “encourages patients to call Anthem using the number on the back of their insurance card to understand options for care after July 1.
Patients with qualifying conditions can be eligible for continuity of care.
Anthem BCBS of Ohio must provide services to members regardless of whether services were prior authorized/pre-certified or the treating provider is in or out-of network with Anthem BCBS of Ohio if they have a qualifying condition.
Information on continuity of care can be found on Mercy Health’s website.
Patients should also call the Ohio Office of Medicaid, 800-324-8680, to understand options for maintaining access to Mercy Health facilities and providers. We participate in all other Medicaid plans in Ohio.”
Only patients who have Elevance Health’s Managed Medicaid plan in Ohio could be impacted by this negotiation.
All other patients with Elevance Health insurance are not impacted at this time.
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This story was originally published June 30, 2023 at 4:07 PM.