Mercy Health, Anthem dispute leaves Medicaid patients in bind

LIMA — Ohioans enrolled in Anthem Blue Cross Blue Shield’s managed Medicaid plans are caught in the crosshairs of a dispute between the insurance company and Bon Secours Mercy Health, which terminated a contract with Anthem in June covering nearly 50,000 Ohioans on Medicaid in an attempt to renegotiate reimbursement rates for Anthem’s employer and individual plans.

The termination, which included a 30-day transition period during which Mercy Health accepted out-of-network rates for Anthem Medicaid plans through July 31, leaves thousands of low-income Ohioans out of network with one of the state’s largest health systems.

“I didn’t know until my mom told me,” said Kris Rex, who was admitted to Mercy Health-St. Rita’s Medical Center for a bone infection and amputation days before her Anthem Medicaid insurance went out of network on July 1.

Rex says she finally received a notification from the hospital Tuesday as she was discharged to a motel room, left with a portable toilet, a wheelchair and a list of nursing homes that accept Anthem Medicaid.

“Why don’t you notify the patients before they come into the hospital, so they have a choice,” Rex said, adding: “They should not have shoved me out the door. They should have kept me until they knew I had a place that was safe, secure and that I can get around in.”

In an emailed statement Friday, a Mercy Health spokesperson said she could not discuss an individual patient’s care but said the health system has notified affected patients via MyChart, the electronic records application, and has communicated with local media and updated its website with information about the changes.

“Mercy Health is committed to the health and well-being of all we serve by providing the highest-quality, most compassionate care,” the statement read. “Discharge recommendations are developed on a case-by-case basis to empower the patient to successfully transition from one level of care to the next. Due to patient privacy, Mercy Health cannot discuss an individual patient’s care.”

Mercy Health officials allege Anthem has engaged in a pattern of payment delays and disputes, resulting in $100 million in late and unpaid claims as of June, at a time when the health system is contending with increased labor and supply costs, prompting the negotiations and contract termination.

An Anthem spokesperson says that figure is “inflated” and that there is always a lag in claims submission and payment.

“To help provide clarity to the issue, Mercy Health terminated their contract with Anthem Medicaid early despite our repeated asks to rescind their termination and protect our Medicaid members in a dispute over pricing in another line of business,” Anthem spokesperson Jeff Blunt said via email. “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.”

Still, Mercy Health asked the Ohio Department of Medicaid this month to reassign all 50,000 Ohioans enrolled in Anthem managed Medicaid plans who have seen a Mercy Health provider in the last 12 months to another managed Medicaid provider, authorize a special open enrollment period and freeze enrollment so new Anthem Medicaid beneficiaries know Mercy Health is no longer in network with Anthem.

ODM rejected those requests in a letter to Mercy Health President Don Kline on Tuesday.

“It is indeed unfortunate that Ohio Medicaid members find themselves in the position of having to make potentially urgent or otherwise significant health care decisions because of a disagreement between two established and committed health care organizations that have told us that they have these members’ best interests at heart,” Ohio Medicaid Director Maureen Corcoran wrote in the letter, which was provided to The Lima News.

“ODM will not use its members as an incentive to force a resolution to that commercial, non-Medicaid disagreement,” she wrote. “I strongly encourage BSMH and Anthem to put their business dispute on another track and leave individuals served by Ohio Medicaid out of it going forward.”

The health system likewise asked ODM to investigate Anthem’s network coverage in Lima and Youngstown, as it provides a “higher level and speciality care which otherwise may not be available” in those regions, and accused Anthem of misleading patients by listing Mercy Health providers in its provider directory after the contract was terminated.

An Anthem spokesperson denied both claims, stating that Mercy Health provided an outdated provider list when Anthem updated its directory and that the insurance company’s provider network “meets or exceeds adequacy requirements.”

The insurance company notified Medicaid patients who had recently been seen by a Mercy Health provider of the change in mid-June, and the company has been calling patients with chronic conditions or medical sensitivities directly, the spokesperson said.