Bon Secours Mercy Health And Anthem BCBS Lock Horns Over Contract Negotiations

Bon Secours Mercy Health is locking horns with Anthem Blue Cross and Blue Shield in the most recent example of a contentious contract negotiation that has been brought into the public eye.

The Ohio-based healthcare organization disclosed on its website that the rates at which Anthem compensates its physicians, nurses, and other professionals are “not sustainable nor market competitive.” According to Bon Secours, the insurance company’s rates are significantly less than the money it receives from other payers. Furthermore, the company’s rates have not kept up with inflation and the rising cost of labor.

The company issued a statement in which it claimed that it is not the only entity bearing the costs associated with Elevance Health’s (Anthem) operations. Elevance Health is the more comprehensive corporate name, whereas regional Anthem plans operate independently in their respective areas.

Bon Secours stated, “Patients and employers often have lengthy delays before receiving a clear explanation of their benefits and associated costs. This often results in patients receiving final statements months to years after services have been provided.”

According to the Ohio Anthem BCBS plan, Bon Secours has notified them that the health system will no longer accept its Medicaid clients after July 1 unless they consent to paying much greater amounts in reimbursement for employer-sponsored and individual health insurance.

Anthem has stated that the decision was made in spite of the fact that the two parties are now bound by a contract that will remain in effect all the way through 2024.

The insurer added that if they decided to agree to the demands for higher rates, in addition to the modest increases they are currently giving under the present contract, the outcome would be greater expenses that would be paid directly by companies and individuals.

A reimbursement dispute between an Anthem plan and Carbon Health, a startup provider located in California, has reached a similar level of intensity. It is unusual for payer-provider contract discussions to become public knowledge; nevertheless, providers have experienced tremendous financial hardship as a result of COVID-19, inflation, and continued labor shortages, and they are attempting to pile on the pressure in order to gain higher prices.

In the notice, Bon Secours instructed its patients to continue seeing their primary care physicians for the time being, and that the healthcare organization would discuss the patients’ available choices at the point in time when it becomes clear that the appointment will take place outside of the network. The system also encouraged Anthem members to contact the insurance provider and demand that it continue to include Bon Secours in the network

Anthem has stated that, in the interest of its commitment to its members, it will encourage access by making it possible for its members to locate a diverse selection of providers within its network.

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