Mercy Health-St. Rita’s Medical Center and Mercy Health physicians practices in Ohio could go out of network for Ohioans covered by Anthem Medicare Advantage on Oct. 1. The health system stopped accepting Anthem’s managed Medicaid coverage in July amid a dispute over reimbursement rates for commercial health plans.
Lima News File Photo
LIMA — Mercy Health notified patients Thursday that it may go out of network for Ohioans enrolled in Anthem Blue Cross Blue Shield Medicare Advantage plans in October unless the insurer agrees to “fairly reimburse the ministry for the cost of providing high-quality care to patients.”
It’s the latest casualty in a dispute over reimbursement rates, which led Bon Secours Mercy Health to terminate a contract with Anthem in July covering nearly 50,000 Ohioans who were enrolled in the insurer’s managed Medicaid plans.
Now, nearly 15,000 Ohioans covered by Anthem’s Medicare Advantage plans could lose access to Ohio’s largest health system on Oct. 1.
Mercy Health officials allege Anthem parent company Elevance Health owes more than $100 million in late or unpaid claims for care already provided — a figure the insurance company disputes — and that the health system is experiencing “significant” operating losses due to inflation, supply and labor costs.
“Mercy Health-St. Rita’s Medical Center has been a bedrock of this community for more than a century and throughout that time, we have delivered high quality care to all in need, with an emphasis on those who are underserved,” Mercy Health-Lima President Ronda Lehman said in a press release Thursday.
“We believe that all patients deserve access to care with providers they trust and Anthem’s refusal to reimburse the full cost of care to Mercy Health while simultaneously bringing in record profits, paid for by patients and employers is unconscionable. We are asking Anthem to return to the negotiating table to resolve his issue.”
Meanwhile, Anthem officials say Mercy Health is asking for rate increases that are three times the rate of inflation and that the health system is using its Medicaid and Medicare Advantage contracts with Anthem, which were set to expire in January 2025, as a “negotiating tactic” to extract higher prices from commercial insurance plans.
“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,” Anthem spokesperson Jeff Blunt said in an emailed statement. “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.”
Mercy Health left Anthem’s Virginia Medicare Advantage plans Aug. 1 and notified the insurance company of its intent to leave its Kentucky Medicare Advantage plans in October.
What to do if you have Anthem Medicare Advantage
There are two options for Ohioans with Anthem Medicare Advantage insurance who see a Mercy Health physician if the health system follows through with its plan to terminate coverage Oct. 1: change health plans or find an in-network health care provider.
Medicare Advantage open enrollment begins Oct. 15, allowing those who want to keep their Mercy Health physician to select another plan with limited disruption.
The health system said in a press release Thursday that Mercy Health will remain in-network with all other major Medicare Advantage health plans in Ohio.
Those who want to keep their Anthem plans can transition to another health provider such as Lima Memorial Health System, which will remain in-network, or ask for continued coverage through a single case agreement between Anthem and their Mercy Health provider for certain serious and complex conditions.
