Some managed Medicaid coverage in jeopardy at Mercy

Anthem managed Medicaid members will not be eligible for “in network” payments at Bon Secours-Mercy Health after June 30 if a dispute between the provider and Anthem insurance is not settled before then. Only patients covered by Anthem managed medicaid will be affected — for now.

The dispute arose over rising costs of labor, drugs and medical supplies. Mercy Health provides patient care at 1,200 sites across seven states, according to its website.

Locally, the company operates St. Elizabeth Youngstown Hospital, St. Elizabeth Boardman Hospital and St. Joseph Warren Hospital, as well as satellite urgent care facilities and doctors’ offices.

Mercy Health said it has been trying to renegotiate its contract and seek a resolution for the past nine months, according to a news release from the health care operator.

“It is important that Elevance Health (Anthem) step up and support the care and well-being of its policyholders and the health care providers who care for them,” the statement reads. “Patients and employers often have lengthy delays before receiving clear explanation of their benefits and associated costs. This often results in patients receiving final statements months to years after services have been provided.”

Anthem has declined further negotiation, according to the statement.

“While this (the dispute) is disappointing, we remain committed to compassionately serving every patient who walks through our doors,” the statement reads.

Anthem was reported to have earnings of $2.8 billion in the first quarter of this year with a 16.6 percent yearly increase, according to a recent Modern Healthcare article. Meanwhile, Elevance Health still owes Mercy over $100 million in late and unpaid claims, according to Mercy Health spokeswoman Kara Franz.


Jeff Blunt, corporate communications director for Anthem, said that Mercy refused to keep the contract with the company.

“This termination comes outside of our existing contract with Mercy Health, that is in effect through 2024, which already acknowledges and addresses the rising cost of providing health care services,” Blunt said.

He said Mercy kept demanding higher rates.

“The rates were three times that of historical inflation,” he said.

Despite the increased rates, Blunt said Anthem has kept in contact with Mercy and fought to keep the contract in place.

“We have repeatedly requested that Mercy Health rescind their termination of our current contract that threatens to put society’s most vulnerable at risk in order to leverage higher revenues from Anthem,” he said.

He also said the increase in payment to Mercy would cause an increase in prices for insurance consumers.

“Mercy Health’s interests are not in the best interest of Ohio consumers, especially to those who are at risk to disruptions in care,” Blunt said.

Franz said via email that more Anthem members could be affected by the dispute in the future if an agreement isn’t reached.

Nationwide health care organizations, including Bon Secours Mercy Health, have experienced a 9.6 percent labor-cost increase and an inflation increase of 6.8 percent from 2021 to 2022.



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