Beginning October 1, Mercy Health facilities may be out-of-network for Medicare Advantage patients in Ohio for Anthem Blue Cross Blue Shield insurance patients.
 
On Thursday, the healthcare network released a statement stating "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."
 
Anthem Medicare Advantage is the supplement insurance seniors can purchase for Part A and Part B.
 
According to Mercy Health, the total number of Medicare patients locally potentially impacted is 15,426.
 

Mercy Health stated the reasons for the need to move Anthem to out-of-network as the healthcare provider has experienced "significant inflationary, labor and supply cost challenges" over the last few years.

Mercy said the provider has had significant health system operating losses, despite operational reductions.

Overall hospital expenses increased 17.5 percent between 2019 and 2022, according to the American Hospital Association, while Medicare reimbursement increased 7.5 percent.

The statement reads: "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," Luellen added.

OPTIONS ANTHEM/MERCY MEDICARE PATIENTS

  • Talk to a Medicare broker or call the Centers for Medicare & Medicaid Services (CMS) at 800-633-4227 to see options. Medicare Advantage Open Enrollment opens October 15.
  • Mercy Health also said that Medicare patients could call the number on the back of their insurance card to discuss with Anthem the need to keep uninterrupted in-network access with a Mercy facility.
  • Patients can also contact Anthem to see what facilities are in-network.
  • Managed Medicaid patients may call the Ohio Medicaid office at 800-324-8680 to initiate a 'Just Cause' transfer to an alternative Managed Medicaid plan if needed to ensure access to Mercy Health facilities and providers.

The release said that Mercy Health is contracted with all Managed Medicaid plans in Ohio - with the exception of Anthem - and will continue to serve patients under their new health plans.

Anthem Blue Cross Blue Shield responded to Mercy's press release stating:
 
"Because Mercy Health has chosen to refuse Anthem Medicare Advantage coverage effective October 1 2023, we are assisting our Medicare Advantage members to transition elective care to one of the many high quality health systems in our network. We are will work to assist members who require continued care with their current provider for certain serious and complex conditions.  
To help clarify this situation, Mercy Health terminated their contract with Anthem Medicaid and Medicare Advantage early in an effort to force a mid-contract cost increase for Anthem members covered through their employer or the Affordable Care Act. The current contract betweeen Anthem and Mercy Health was set to expire January 1, 2025 and includes annual increases to account for inflation and labor cost increases. Mercy Health, however, is now demanding increases that are three times the current inflation rate."
 
The response added, "We have repeatedly asked Mercy Health to rescind this termination and protect Medicare Advantage and Medicaid members in a dispute over pricing in a completely different 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."
 
Anthem suggested Medicare Advantage recipient to visit Anthem.com/bsm
 
This announcement followed the July announcement that Mercy Health patients with Anthem Managed Medicaid insurance could no longer see Mercy Health providers or schedule appointments without an approved Continuity of Care form from Anthem.