Mercy Health cuts ties with Anthem Blue Cross and Blue Shield, patients must make a decision
You may recall back in June, 21 News did a story on Mercy Health and Anthem Ohio Blue Cross and Blue Shield struggling to come to a contractual agreement for patients.
The deadline was July 1st and no agreement was ever made. Instead, Mercy Health has severed ties with Anthem and is telling their patients to switch over to another insurance provider.
Mercy claims in a statement that "...Anthem leadership refuses to meet and engage in negotiations with Mercy Health leadership," while Anthem representatives say Mercy Health terminated the contract early and, "...has chosen to refuse Anthem Medicaid coverage..."
All of this trickles down to the patients. Fifty thousand people are insured with Anthem and must now find another plan if they want to continue receiving care from Mercy Health.
Anthem says this all stems from financial disagreements, citing "...a dispute over pricing in another line of business..." and that Mercy Health is "...needlessly disrupting care for thousands of vulnerable people as a negotiating tactic..."
Mercy Health's statement reads in part: "...contracts with Anthem have not kept pace with the rising cost of labor, supplies and medications, undermining our ability to provide care now and into the future..."
Mercy Health has also asked the Ohio Department of Medicaid to automatically remove their patients from Anthem and not allow others to enroll without knowledge of what's going on between the two, but the department of Medicaid declined. So, patients will have to switch care themeleves if they so choose.
If you want to stay a Mercy Health patient, you need to initiate what's called a 'just cause' transfer. This will start the process of moving those insured under Anthem to an alternate Managed Medicaid plan.
You can start that process by calling the Ohio Medicaid office at 800-324-8680. Your other option is to work with Anthem, give them a call and work out a transition plan for care.
Full statements with information from both parties as follows:
Mercy Health
"Anthem Ohio Managed Medicaid patients can switch plans by calling 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.
On July 1, Mercy Health became out of network for Anthem Managed Medicaid members in Ohio.
Since then, Mercy Health has been actively communicating with our patients to ensure they are fully aware of their options, including offering guidance on how to change to any of the other six Managed Medicaid health plans offered, all with which Mercy Health participates.
Despite these efforts, Mercy Health remains disappointed that Anthem continues to mislead their members by failing to update its provider directory noting that
Mercy Health is no longer in Anthem's Managed Medicaid network, falsely giving the impression that Mercy Health remains in-network.
Additionally, Mercy Health has received feedback from patients that upon inquiry to Anthem, Anthem has been inaccurately informing patients that there is no need to change health plans as Mercy Health remains contracted with Anthem.
This -misrepresentation demonstrates a pattern by Anthem to take actions aimed at maximizing profit, at the expense of patients. Mercy Health's current contracts with Anthem have not kept pace with the rising cost of labor, supplies and medications, undermining our ability to provide care now and into the future.
This while Anthem, once again, posted a Q2 2023 earnings statement, released on July 19, that showed a YTD operating income of $5.5B, a 14.4% increase from the same period in 2022.Anthem leadership refuses to meet and engage in negotiations with Mercy Health leadership, leaving thousands of Anthem Ohio Managed Medicaid patients without access to their trusted doctors.
To further support our patients and communities, Mercy Health has reached out to the Ohio Department of Medicaid asking for:
- Reassignment all 50 thousand Anthem Managed Medicaid beneficiaries who have seen a Mercy Health provider in the last 12 months
- Enrollment freeze on Anthem so no new individuals enroll without understanding Mercy Health is no longer participating with Anthem
- Special open enrollment period so anyone can switch if they so choose
- Investigating Anthem's lack of network adequacy for Youngstown and Lima areas Mercy Health's continues to be focused on caring for the poor and underserved.
As a faith-based organization, our mission calls us to lead with humanity and compassion, and we remain steadfast in our commitment to serve those in need. Mercy Health is committed to remaining transparent and will update mercy.com/elevancehealth with the latest information."
Anthem Blue Cross and Blue Shield
Because Mercy Health has chosen to refuse Anthem Medicaid coverage effective August 1, 2023, we are assisting our Medicaid members to transition elective care to one of the many high quality health systems in our network.
We are also working with Mercy Health to assist members who require continued care with their current provider for certain serious and complex conditions.
Anthem's care provider network meets or exceeds adequacy requirements in every location Mercy Health offers services and we are continually evaluating our network to ensure care availability for those we serve.
To help provide clarity on the issue, Mercy Health terminated their contract with Anthem Medicaid early despite our repeated asks to rescind their termination and protect our Medicaid members in a dispute over pricing in another line of business.
They are needlessly disrupting care for thousands of vulnerable people as a negotiating tactic to force higher prices on people covered through their employers or the Affordable Care Act.
Regarding provider directories:
Before terminating their contract and leaving Anthem's network, Mercy Health provided us with a list of their care providers to be removed from Anthem's directory.
As of July 1, 2023, all providers on that list were removed. However, the list provided by Mercy Health was inaccurate and out of date. We've been working as quickly as possible since then to correct that list and remove the remaining providers.
