×

Mercy Health, Anthem reach deal

Contract provides care to members through ’28

Bon Secours Mercy Health and Anthem Blue Cross Blue Shield in Ohio have reached a multi-year agreement that allows Anthem enrollees to continue to get care at Mercy Health hospitals, outpatient care centers and by their doctors.

The agreement, which ends a lingering contract dispute between the health care and insurance providers, means all Anthem Medicare Advantage and Medicaid health plan members will have continued in-network coverage at Mercy Health, according to a news release.

In addition, Anthem has agreed to cover any patient claims since July 1, the period of time when Mercy Health was out-of-network with Anthem Medicaid.

The agreement, which also extends coverage for Anthem employer-based and Affordable Care Act plans, runs through 2028, the release states.

“We worked together to creatively address affordability for our members and the financial needs of an important care provider,” Anthem Ohio President Jane Peterson said. “This agreement provides long-term stable access to care at Mercy Health without cost increases for our members and employers.”

Said Dr. John Luellen, president, Mercy Health-Lorain and Youngstown, “We understand that being out of network can be very difficult, and we are pleased that patients with Anthem insurance can now see our physicians and use our hospitals at an in-network cost. We sincerely believe that access to quality health care services is vital for our communities. This new agreement protects our patients’ access to compassionate care close to home.”

Details of the agreement are not being released because of confidentiality provisions in the contract.

As part of the agreement, Mercy Health agreed to dismiss a lawsuit it filed against Anthem in Virginia as the organizations form collaborative teams to address claims submissions and payment processes, the release states.

The contract dispute over rates between the Cincinnati-based health care system and the Indianapolis-based Anthem goes back several months.

At first, it involved managed Medicaid beneficiaries. When new contract talks stalled, Mercy Health became out of network for those patients with Anthem Ohio on July 1. About 3,500 people in the Mahoning Valley were impacted.

Mercy Health 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.

Last month, Mercy Health announced there were continuing talks over Anthem reimbursements regarding Medicare Advantage patients and set Sunday as the day when Mercy Health hospitals and physicians would be out of network.

Similarly, Mercy Health argued the payments had not kept up with inflation and labor and supply cost challenges.

Anthem said 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 would have expired Jan. 1. It, according to Anthem, included increases yearly for inflation and labor costs, but Mercy Health wanted increases that were three times the rate of inflation.

About 15,000 patients in the Youngstown area would have been affected if not for the new agreement.

NEWSLETTER

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 $2.99/week.

Subscribe Today