Mercy Health, Elevance negotiations stalled

LIMA — Negotiations between Mercy Health and Anthem stalled as the health system seeks higher reimbursement rates it says are needed to keep pace with inflation.

If a resolution is not reached by June 30, Mercy Health will no longer accept Anthem Medicaid plans at its Ohio physician practices and hospitals in Lima, Cincinnati, Lorain, Springfield, Toledo and Youngstown.

Other Anthem Ohio plans may be affected too if an agreement is not reached soon.

“Our current contracts with Elevance Health (Anthem) have not kept pace with the rising costs 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,” a message from Mercy Health to patients says.

The message claims Elevance Health owes Bon Secours Mercy Health more than $100 million in late and unpaid claims. Meanwhile, the insurance company reported earnings of $2.8 billion in the first quarter of 2023.

Mercy Health is urging patients with Anthem insurance to contact the insurance company about the pending changes.

Still, a representative from Anthem said in an email Thursday that Bon Secours Mercy Health notified the insurance company that it will no longer accept Anthem Medicaid after June 30 unless Anthem agrees to increase reimbursement rates for employer-sponsored and individual health plans.

Those rates are “three times that of historical inflation,” the email said.

A statement from Anthem says “this termination comes outside of our existing contract with Bon Secours Mercy Health that is in effect through 2024, which already acknowledges and addresses the rising cost of providing healthcare services.

“This is a fair, mutually agreed upon contract that allows us to partner to meet the health needs of those we serve,” the statement continues. “We have repeatedly requested that Bon Secours 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.

“They have refused to do so. If we were to agree to their requests for higher rates, on top of the reasonable increases we are already providing, the result would be higher costs borne directly by businesses and individuals across Ohio. Bon Secours Mercy Health’s actions are not in the best interests of Ohio consumers, especially those who are most at-risk to disruptions in care. Anthem remains committed to the people of Ohio and through our broad network of care providers, we will ensure all of our members have access to the care they need.”