Anthem, Mercy Health reach agreement to continue care, dismiss lawsuit

PADUCAH — Anthem Medicare Advantage members will have access to Anthem Healthcare at Mercy Health until 2028, after a potential rift developed between the provider and insurer over the summer.

According to a Friday news release, Mercy Health and Anthem Blue Cross and Blue Shield have reached a multi-year agreement to provide Anthem members with continued access to care at all Mercy Health hospitals, outpatient care centers, and physician offices. Mercy Health operates 23 hospitals across Ohio and Kentucky, with hundreds of clinics, urgent care, and medical center locations — including in Paducah.

This comes after Mercy Health announced in July it was considering splitting from Anthem, now known as Elevance Health.

At the time, Mercy said only patients with Anthem's Managed Medicaid plan in Ohio could be impacted by negotiations, but other patients could be impacted soon.

They released a statement that read, in part:

"Our current contracts with Elevance Health (Anthem) have not kept pace with the rising cost of labor, supplies and drugs, undermining our ability to provide care now and into the future, and over the last nine months, we have been negotiating in good faith with Elevance Health (Anthem) to change that."

Mercy said Anthem had not kept up with outcomes of inflation and owed more than $100 million in late and unpaid claims.

A response from Anthem read, in part:

"Bon Secours-Mercy Health has notified us of its intent to no longer accept Anthem Medicare Advantage members in Kentucky after Sept. 30 unless we agree to provide them increased reimbursement rates from our employer-sponsored and individual health plans. This demand comes in spite of the fact that we already have a contract in place through 2024 that accounts for the rising costs of delivering healthcare. Unfortunately, their actions to obtain higher revenues from Anthem threaten to put Medicare members at risk."

In August, Mercy Health filed a lawsuit against the insurer alleging that it owed more than $93 million in unpaid claims. In the suit, Virginia health systems claimed they had been pushing local Anthem Blue Cross and Blue Shield plans to pay outstanding claims for nearly four years, and "finally decided that enough was enough."

Now, the two agencies have reached an agreement that provides continued access to Anthem and extends coverage for Anthem employer-based and Affordable Care Act plans.

In a statement included in the release, Anthem Kentucky Medicare Leader Dave Mull said the agency worked with Mercy Health to address affordability for their members and financial needs of care providers. "This agreement provides long-term stable access to care at Mercy Health without cost increases for our members and employers," he said. "I'm proud that both organizations continued to focus on our shared priority: the communities we serve."

"We are pleased that patients with Anthem insurance can now see our physicians and use our hospitals at an in-network cost," said Mike Yungmann, Mercy Health President of Kentucky, in a statement included in the release. "We sincerely believe that access to quality health care services is vital for our communities."

Details of the agreement are not being released due to confidentiality provisions in the contract. However, as part of the agreement, Mercy Health will dismiss the Virginia lawsuit as the organizations form teams to address claims submissions and payment processes.

Anthem members may contact the Member Service phone number on their Anthem ID card for assistance with any questions, and Mercy Health patients can call 888-354-0205 for more information.