Mercy Health notifies Ohio Medicare Advantage patients that Anthem plans may be out-of-network on Oct. 1

Mercy Health sent out a press release Thursday afternoon saying the hospital may be out-of-network for Medicare Advantage patients in Ohio.

Here is the full statement from the hospital system.

Statement from Mercy Health

As of October 1, 2023, Mercy Health may be out-of-network for Medicare Advantage patients in Ohio following months of negotiations with Elevance Health (Anthem) to fairly reimburse the ministry for the cost of providing high-quality care to patients. Anthem’s current reimbursements – which are substantially less than other payers – have not kept up with inflation and are overwhelmingly inadequate to account for the cost of providing safe and quality care.

Mercy Health has experienced significant inflationary, labor and supply cost challenges over the last several years which has led to significant health system operating losses, despite the organization making operational cuts. As a result, the ministry has had to pay substantially more for costs incurred to care for our patients. Mercy Health is not alone in these challenges. The American Hospital Association reported industry-wide increases of nearly 21% for labor costs, nearly 20% for hospital drug costs and nearly 19% for medical supply costs per patient since 2019.

“For more than a century, Mercy Health has compassionately cared for the people of the Mahoning Valley, especially those who are poor, dying and underserved. We believe every patient deserves access to high-quality care and the providers they know and trust,” said Dr. John Luellen, president, Mercy Health – Lorain and Youngstown. “Anthem’s refusal to reimburse the full cost of care to Mercy Health while simultaneously bringing in record profits, paid for by patients and employers, is unconscionable. We implore Anthem to return to the negotiation table to resolve this issue.”

Last month, Anthem reported operating revenue growth of 12.7% year over year to $43.4 billion.

In most cases, changing insurance plans can help ensure Mercy Health remains in-network. Mercy Health recognizes that changing insurers can be overwhelming and time consuming, and is here to support patients as they evaluate options. To help plan for the possible October 1 transition, patients with Medicare Advantage insurance in Ohio should:

Talk to their broker or call the Centers for Medicare & Medicaid Services (CMS) at 800-633-4227 to explore options. Medicare Advantage Open Enrollment opens October 15. Mercy Health remains in-network with all other major Medicare Advantage health plans in Ohio.

Call the number at the back of their insurance card to tell Anthem Blue Cross Blue Shield how important it is to keep uninterrupted in-network access to Mercy Health.

Managed Medicaid patients should call the Ohio Office of Medicaid at 800-324-8680 to initiate a Just Cause transfer to an alternative Managed Medicaid plan to ensure that they can retain long-term access to their Mercy Health facilities and Providers. Mercy Health is contracted with all Managed Medicaid plans in Ohio, with the exception of Anthem, and we will continue to serve our patients under their new health plans.

We have been actively seeking resolution, especially knowing that we aren’t the only ones shouldering the burden of Anthem’s practices. Patients and employers often have lengthy delays before receiving explanation of benefits and associated costs. As a result, it can take patients months to years to receive final statements.

Mercy Health physicians, nurses and other health care professionals have proudly served our communities for more than 100 years. Anthem has overlooked the needs of the community with its inadequate reimbursement for the health care services our employees provide.

Additionally, Anthem refuses to pay for more than $100 million in services that have already been provided to patients covered under their plans. These unpaid claims continue to increase each day. Furthermore, Anthem has conducted nearly triple the rate of historic audits in recent months to increase the administrative burden as retaliation for stalled negotiations.

Anthem consistently chooses shareholder profits over patient care.

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