Anthem, Bon Secours remain at impasse

Anthem, Bon Secours remain at impasse

Published 5:12 pm Wednesday, August 9, 2023

By Titus Mohler

Anthem Blue Cross and Blue Shield and Bon Secours Mercy Health remained at an impasse as of Tuesday, Aug. 1, amid negotiations that Bon Secours noted would impact patients in Virginia with Anthem Medicare Advantage as their primary insurance.

"Patients in Virginia with Anthem employer-provided plans, plans purchased directly from Anthem, or those patients with Anthem Medicaid are not impacted," BSMH Public Relations and Communication Director Emma Swann said.

In a July 13 news release, Bon Secours officials stated, "If Bon Secours is not able to reach an agreement beforehand, our Medicare Advantage contract with Anthem in Virginia will terminate effective Aug. 1, and Bon Secours nurses, doctors and caregivers will be considered out-of-network for nearly 19,000 patients who have Anthem Medicare Advantage health insurance."

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The release noted that this could mean that patients with Medicare Advantage insurance would have to pay more out-of-pocket to continue seeing their Bon Secours providers.

Bon Secours officials described this situation as "incredibly disheartening."

"What Anthem BCBS pays our doctors, nurses and other caregivers is not equitable or market competitive," the officials stated. "Their current reimbursement rates — which are substantially less than those we receive from other payer partners in the market — have not kept up with inflation or labor costs and are overwhelmingly inadequate to account for the cost of providing safe and quality care."

ANTHEM'S RESPONSE TO BON SECOURS

Anthem BCBS in Virginia issued a response on Friday, July 28, to Bon Secours' July 13 release.

Monica Schmude, president of Anthem BCBS in Virginia, stated, "Bon Secours Mercy Health has deployed a deeply concerning new tactic in its recent negotiations with Anthem Blue Cross and Blue Shield: Using health care access for at-risk Medicare Advantage and Medicaid populations as a bargaining chip in trying to raise prices for people who have health coverage through their employer or the Affordable Care Act.

"In short: Bon Secours Mercy Health terminated its provider contracts relating to Anthem's Medicare Advantage and Medicaid members in an effort to get to higher rates from its employer-sponsored customers," she wrote.

She stated that as a result, about 11,000 Virginians with Anthem Medicare Advantage coverage would lose access to affordable health care services at Bon Secours Mercy Health on Aug. 1.

"This is already creating confusion and care disruption for many of the most vulnerable people in our community," Schmude wrote. "Our team at Anthem has been working diligently to ensure continued treatment with their current doctor for people with certain serious and complex conditions. But Bon Secours' decision means that most of their patients with Anthem Medicare Advantage coverage will be forced to find alternative doctors and hospitals."

Schmude noted that it is important for Anthem members and the community to understand how this situation came about.

She wrote that in 2022, new BSMH and Anthem contracts went into effect for Anthem's Medicaid, Medicare Advantage, employer-sponsored and ACA health plan members. These agreements provided Anthem members with in-network health care access at Bon Secours and were set to last until Jan. 1, 2025.

"Just one year into its three-year agreement, Bon Secours told Anthem that it wanted to charge more for Anthem members with employer-sponsored and ACA health plans," Schmude stated. "Further, its demands for price increases were more than three times the current hospital inflation rate and the annual increases agreed to in the current contract. Notably, it did not ask for more money for care received by Medicaid members."

She stated that to secure these price hikes, BSMH told Anthem that it would stop accepting Medicare Advantage and Medicaid members unless Anthem agreed to the higher employer-based and ACA prices.

"This was nothing less than using these vulnerable populations as leverage to force increased payments from employers and individuals," Schmude wrote.

"Bon Secours Mercy Health has also been disingenuous about why this is happening," she continued. "Recently, they issued a press release describing this situation as 'incredibly disheartening,' stating that patients with Medicare Advantage insurance would have to pay more out-of-pocket to continue seeing their Bon Secours providers."

Adding emphasis to her two usages of the word "chose," Schmude wrote, "Bon Secours chose to become out of network for Anthem Medicare Advantage members in Virginia. This was not a given 'next step' in the process. Bon Secours chose to terminate the provider contracts relating to Anthem's Medicare Advantage and Medicaid members in the middle of the three-year agreements, despite our requests to rescind their termination and rejoin our discussions to find a reasonable solution."

Schmude then addressed the impact for people in the community.

"More than any other population, people covered by Medicare Advantage and Medicaid are sensitive to medical care disruptions," she stated. "Changing doctors, finding transportation and dozens of other factors often present difficult barriers to care — barriers that lead to missed appointments, skipped screenings and unmanaged chronic conditions. Putting these vulnerable groups in jeopardy to seek higher prices from other patients is as baffling as it is distressing for our community.

"From the moment we were informed of this startling demand, Anthem has been committed to preserving access, repeatedly requesting that Bon Secours Mercy Health continue serving Medicare Advantage members while working toward a resolution," Schmude continued. "But Bon Secours Mercy Health has decided to continue with the termination of more than 11,000 Virginia Medicare Advantage members starting on Aug. 1. It also plans to no longer accept Anthem coverage for almost 40,000 Medicaid members starting Oct. 1, causing massive health care disruption for almost 50,000 Virginians. And Virginia is not the only state they are manipulating with these tactics."

Schmude noted that while negotiations between hospitals and health plans are an ordinary part of the health care system, she described the tactics of BSMH as "anything but ordinary."

"This is the first time in my experience that a health care provider has broken a contract for one group of members to demand price increases from an entirely different group of members," she wrote. "And sadly, it's now part of a Bon Secours Mercy Health pattern of putting vulnerable patients at risk to increase its profits."

She stated that it is time to come together to put Virginians' best interests first.

"Our ask is simple: That Bon Secours Mercy Health stop using vulnerable populations as bargaining chips and work together to reach an agreement," Schmude wrote. "Now more than ever, hospitals and health plans must collaborate. I remain committed to that course so that our families and neighbors continue to have access to high-quality, affordable health care."

BON SECOURS ISSUES RESPONSE ON AUG. 1

After briefly seeing some excerpts from Anthem's July 28 release, Bon Secours Mercy Health issued a response on Aug. 1.

"For decades, we have been providing health care to our community," Bon Secours officials stated. "Our focus is, and will always be, providing quality, compassionate care for each person who comes through our door. We want to continue to negotiate to ensure access to care is available when it's needed. We encourage Anthem to do what is right for its Virginia Medicare Advantage members, today and in the future, to ensure access to care is not compromised.

"Despite months of ongoing contract negotiations, Anthem hasn't provided a contract that addresses the financial burden created by recent inflation and supply chain shortages and (that will) build a sustainable partnership that will support the quality care we offer our communities for years to come," BCMH officials continued.

"As a result, effective Aug. 1, our Bon Secours providers and facilities are now out-of-network for patients in Virginia with Anthem Medicare Advantage plans," the officials stated.

The officials noted that all patients will continue to have access to all Bon Secours emergency departments, regardless of the network status with Anthem.

The Aug. 1 news release also stated that Medicare Advantage open enrollment starts Oct. 15.

BCMH officials encouraged patients to talk to their brokers or call the Centers for Medicare & Medicaid Services at 1-800-633-4227 to explore their options. Officials added that Bon Secours remains in-network with all other major Medicare Advantage health plans in Virginia.

"Bon Secours is committed to remaining transparent and will update bonsecours.com/elevancehealth with the latest information," officials stated.

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