UC Health, Anthem dispute reimbursement rates [Hamilton JournalNews, Ohio]

March 23--Active negotiations between health insurer Anthem Blue Cross and Blue Shield and Cincinnati hospital group UC Health over reimbursement rates is the latest health provider/payer dispute made public.

This time Anthem and UC health are negotiating rates Anthem pays for care its members receive from UC Health services. The current contract expires April 15.

If an agreement isn't reached, Anthem members might have to pay higher out-of-network costs for UC Health services, or find a different provider that accepts Anthem plans.

The current Anthem contract with UC Health was negotiated two years ago and included higher payment rates than the one before, according to Anthem spokeswoman Kim Ashley.

Anthem is Ohio's largest health insurer with about 3.3 million members statewide. The contract with UC Health covers about 14,000 people, the estimate of how many Anthem members have used UC Health services the past 12 months, according to Anthem.

"We'd like to clarify that UC Health chose to terminate its contract with Anthem, demanding higher reimbursement. UC Health is already the most highly reimbursed hospital system in Greater Cincinnati and they are demanding their physicians be paid more than other local physicians," said a written statement from Anthem released to media. "The hospital and physician contracts that we negotiate on behalf of our customers directly impact what they pay for their medical care."

Higher hospital reimbursement rates are reflected in insurance premium rates, affecting costs of care, Ashley said.

UC Health owns several hospitals, including West Chester Hospital in Butler County, and the doctor's group UC Physicians.

UC Health took to its Twitter page Thursday to post a statement saying it did not choose to terminate the Anthem contract. In the written statement UC Health claims the opposite, that Anthem proposed a new contract with reimbursement rates below the rates paid to other academic medical centers in the region.

"It is our hope that Anthem recognizes the level of care we provide to their members and to the region as its only level one trauma hospital...," the statement reads online. "We struggle daily with representatives of large for profit insurance companies as they often find ways to deny one of their own members' medical claims which serves the best interest of the insurance company and not its members."

Most times contract negotiations and re-negotiations transpire without disputes between the two parties, said Susan Millerick, spokeswoman for Aetna, another major Ohio health insurance carrier. Aetna has approximately 700,000 Ohio members.

"Although we do have occasions where we simply are unable to reach terms with a health care provider, we are working hard to get past an era of disputes to one characterized by collaboration." Millerick said in an email. "Increasingly, we are working closely with hospital systems to develop innovative, new reimbursement models based on value and good health outcomes vs. services provided."

UC Health and Aetna confronted a similar issue in 2011 to the one between Anthem and UC now. Aetna and UC Health had a contract that terminated January 2011, which impacted West Chester and Fort Hamilton Hospitals.

UC Health is the successor to the former Health Alliance of Greater Cincinnati system, of which Fort Hamilton was previously a member.

In August 2012, UC Health and Aetna announced they reached a new contract for coverage through July 31, 2015, that covers 165,000 patients.

Fort Hamilton was rolled into Kettering Health Network's contract with Aetna. Fort Hamilton joined Kettering Health in July 2010.

PriMed Physicians, an independent physician group with sites in Greene, Montgomery and Warren counties, had a payment dispute with Aetna in 2012 affecting about 4,800 patients. The physicians group's contract with Aetna expired Nov. 1 last year.

The parties have not reached a new agreement, said Jim Moffett, executive director of PriMed.

"This situation with Aetna is the first time we've ever gone out of network with a carrier," Moffett said.

Many affected patients stayed with PriMed, but their rates are higher, he said. Some employers also changed to other carriers PriMed is contracted with, he said.

"Aetna was uncomfortable paying us a rate we felt we needed to provide the quality of care we're committed to giving our patients," he said, noting he respects Aetna. "We feel stuck somewhat and hope that we will be able to contract with Aetna."

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