Ongoing dispute between Mercy Health, Anthem could affect more than 15,000 in local area

WARREN — Come Oct. 1, Bon Secours Mercy Health hospitals and physicians may be out of network for nearly 15,000 Medicare Advantage patients in the Youngstown area enrolled with Anthem Blue Cross Blue Shield.

The health care system announced Thursday there have been ongoing talks between the parties over Anthem’s reimbursements, which Bon Secours Mercy Health claims “have not kept up with inflation and are overwhelmingly inadequate” to pay for quality care.

A release also states Mercy Health, like other health care providers, has experienced “significant inflationary, labor and supply cost challenges” that have led to operating losses despite it making operational cuts.

Dr. John Luellen, president of Mercy Health-Lorain and Youngstown, said in the release that Anthem’s refusal to reimburse the full cost of care is “unconscionable” while recording record profits.

Anthem, according to Mercy Health, last month reported operating revenue of $43.4 billion, a 12.7 percent year-over-year increase.

Anthem spokesman Jeff Blunt said in an email Mercy Health terminated its contract with Anthem Medicaid and Medicare Advantage early to try to force a mid-contract cost increase for its members covered by the employer or the Affordable Care Act.

The contract expires Jan. 1 and includes yearly increases to account for inflation and increased labor costs, however, Mercy Health “is now demanding increases that are three times the current inflation rate,” Blunt said.

Luellen said, “We implore Anthem to return to the negotiation table to resolve this issue.”

Said Blunt, “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,” Blunt said.

Mercy Health’s release states Anthem “consistently chooses shareholder profits over patient care.”

Medicare is federal health insurance for anyone 65 and older and for some people younger than 65 with certain disabilities or conditions.

Medicare Advantage, also known as Part C, is different from original Medicare. Advantage plans are not managed by the government, but rather Medicare Advantage is a Medicare-approved plan from a private insurer as an alternative to the original.

Advantage plans include hospital and medical insurance, and usually prescription drug coverage.

The disagreement is the latest between the Cincinnati-based health care system and the Indianapolis-based Anthem.

A lingering contract dispute over rates for Anthem-managed Medicaid beneficiaries caused Mercy Health to set a July 1 termination date, after which Mercy Health doctors and facilities became out of network for those patients.

Mercy Health similarly argued it needed higher rates because it has experienced inflationary, labor and supply cost increases.

Anthem, however, said Mercy Health’s desired rate is more than double the rate of hospital inflation and accused Mercy Health of trying to leverage higher rates from non-Medicaid members by terminating Medicaid members.

About 3,500 people in the Mahoning Valley were impacted.


Today's breaking news and more in your inbox

I'm interested in (please check all that apply)
Are you a paying subscriber to the newspaper? *


Starting at $4.85/week.

Subscribe Today