Mercy Health Anthem Threatens Medicaid Contract Termination

Bon Secours Mercy Health plans to terminate its insurance contract with Medicaid Anthem Blue Cross Blue Shield It covers 10,000 Ohioans unless the parties negotiate a new contract by June 30.

The two companies currently have a contract through 2024 to provide Medicaid insurance to patients at Mercy’s 21 hospitals in Ohio. But the health system has notified its patients that if a new “fair” deal isn’t reached by June 30, Mercy Ohio hospitals will no longer be in-network for patients receiving Managed Medicaid the following day.

A representative for Mercy Health declined an interview request, but in a statement cited the company’s 6.8% increase in operating expenses from 2021 to 2022 as the reason it needed to renegotiate some of its contracts.

“Mhret Health has contracted with health insurance companies (private payers) such as Elevens Health (otherwise known as Anthem) to ensure that the ministry fairly reimburses the cost of providing high quality care to our patients,” Mhret Health wrote in a statement. “Unfortunately, Elevens Health’s current payments — significantly lower than other payers — have not kept pace with inflation and are insufficient to cover the costs of providing safe, quality care.”

Disputed Negotiations: Hospitals and insurance companies face off in a contract war

In a Q&A on the Cincinnati-based company’s website, Mercy said, “The pay we pay our doctors, nurses and other caregivers is not sustainable or competitive in the market” as to why the contract was terminated.

While negotiations are underway, Anthem spokesman Jeff Blunt said talks between the two have “ceased.”

“(Bon Secours-Mercy Health) has notified us of its intention to not accept Anthem Medicaid members unless we agree to increase the rate of payment for employer-sponsored and individual health plans,” Blunt wrote in a statement to the Enquirer. “We have a contract with Bon Secours-Mercy through 2024, which includes year-over-year increases in the provision of health care services and increased health care services. This is a fair, mutual agreement that allows us to partner. to meet.”

Blunt went on to say that the move from Mercy Health “puts society’s most vulnerable at risk to take advantage of higher incomes.”

“If we agree to their request, in addition to higher rates, the result will be higher costs paid directly by businesses and individuals in Ohio,” Blunt said.

The dispute between Cincinnati hospitals and insurance companies continues.

The latest controversy follows an increase in stalled negotiations and disputes between hospitals and insurance companies, particularly in Cincinnati.

Song and Christ Hospital in the last hours of March They have reached an agreement Retaining employer-based insurance for 100,000 people after months of contentious negotiations.

That followed similar disagreements between them that turned into last-minute deals. Mercy Health and Signa In January, and Cincinnati Children’s Hospital Medical Center and CareSource Ohio Last June.

In each case, negotiators threaten affected patients with being out of network, creating anxious panic if a deal isn’t reached.

“It’s scary. It’s scary when you’re in your 70s and you’re thinking about trying to do all of this,” Sara Duffy told the Inquirer in March, days before the 11th-hour deal between Christ Hospital and you.

Mercy Health has six hospitals in the Cincinnati market. Beyond Ohio, it has hospitals in Lima, Lorain, Springfield, Toledo and Youngstown.

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