Mercy Health, Anthem dispute

TOLEDO — Mercy Health may be out-of-network for Anthem Medicare Advantage patients in Ohio beginning Oct. 1 following months of negotiations with Elevance Health (Anthem) to fairly reimburse the ministry for the cost of providing care to patients. According to a Mercy Health news release, Anthem's reimbursements – which are substantially less than other payers – have not kept up with inflation and are overwhelmingly inadequate to account for the cost of providing safe and quality care. The release said the change would impact all Ohio physician practices and most Mercy Health hospitals in Ohio. However, hospitals in the Toledo market would remain in-network at this time due to a different contract termination date. The release said Mercy Health has experienced labor and supply cost challenges over the last several years which has led to health system operating losses, despite the organization making operational cuts. As a result, the ministry has had to pay more for costs incurred to care for patients, the release said. Mercy Health is not alone in these challenges, the release said. The American Hospital Association reported industry-wide increases of nearly 21% for labor costs, nearly 20% for hospital drug costs and nearly 19% for medical supply costs per patient since 2019, the release said. "Mercy Health has served the Toledo community, with emphasis on those who are underserved, for more than 165 years, and we strongly believe that all patients deserve access to high quality care with providers they trust," said Bob Baxter, president of Mercy Health - Toledo, said in the release. "This commitment to our community is in stark contrast to Anthem's refusal to fairly reimburse for the cost of care while simultaneously bringing in record profits, paid for by patients and employers. We implore Anthem to return to the negotiation table to resolve this issue." Last month, the release said Anthem reported operating revenue growth of 12.7% year over year to $43.4 billion. In most cases, the release said changing insurance plans can help ensure Mercy Health remains in-network. Mercy Health recognizes that changing insurers can be overwhelming and time consuming and has offered to support patients as they evaluate options. To help plan for the possible Oct. 1 transition, the release said patients with Medicare Advantage insurance in Ohio should: • Talk to their broker or call the Centers for Medicare & Medicaid Services at 800-633-4227 to explore options. Medicare Advantage Open Enrollment opens Oct. 15. Mercy Health remains in-network with all other major Medicare Advantage health plans in Ohio. • Call the number at the back of their insurance card to tell Anthem Blue Cross Blue Shield how important it is to keep uninterrupted in-network access to Mercy Health. Additionally, the release said Anthem Managed Medicaid patients should call the Ohio Office of Medicaid at 800-324-8680 to initiate a Just Cause transfer to an alternative Managed Medicaid plan to ensure they can retain long-term access to their Mercy Health facilities and providers. Mercy Health is contracted with all Managed Medicaid plans in Ohio, with the exception of Anthem, and plans to continue to serve patients under their new health plans. The release said Mercy Health has been actively seeking resolution, the release said. Patients and employers often have lengthy delays before receiving explanation of benefits and associated costs. As a result, it can take patients months to years to receive final statements. More information can be found at www.mercy.com/elevancehealth.