Negotiations between Anthem, Mercy Health have stalled

LORAIN — Negotiations between health care providers for some local Medicaid patients have stalled. Anthem, also known as Elevance Health, and Bon Secours/Mercy Health have been negotiating for the past nine months regarding reimbursement for care, according to a news release from Mercy Health. Those negotiations have stalled, Mercy Health said in its news release. The current contract has allegedly not kept up with the hospital system's rising cost of labor, supplies and medications, "undermining our ability to provide care now and into the future." According to Mercy Health, the hospital has experienced significant inflation in labor and supply costs. Labor costs have risen more than 9 percent, while supply chain shortages and other factors have increased operating expenses and care cost by nearly 7 percent from 2021 to 2022. Mercy Health's statement said Elevance owes Bon Secours/Mercy Health more than $100 million in late and unpaid claims. "We have been actively seeking resolution, especially knowing that Mercy Health is not the only one shouldering the burden of Elevance Health's (Anthem) practices," Mercy Health's statement said. "Patients and employers often have lengthy delays before receiving clear explanation of their benefits and associated costs. This often results in patients receiving final statements months to years after services have been provided." Failing to reach an agreement may mean patients with Elevance Health/Anthem insurance may be forced to leave the Mercy Health network, according to the hospital system. In a statement to The Chronicle-Telegram, Anthem Corporate Communications Director Jeff Blunt said Bon Secours Mercy health notified the insurance provider it will no longer accept Anthem Medicaid and Medicare Advantage members unless it raises reimbursement rates for empower-sponsored and individual health plans. According to Anthem, the rates requested are three times that of current hospital inflation. Anthem's contract with Bon Secours Mercy Health runs through Jan. 1, 2025. "This is a fair, mutually agreed upon contract that allows us to partner to meet the health needs of those we serve," Blunt said in the statement. He said Anthem/Elevance Health has repeatedly asked Bon Secours Mercy Health rescind its termination of the contract. Unless an agreement is made, Anthem Medicaid members may pay more for care at Mercy Health after June 30, and Anthem Medicare Advantage members may pay more after Sept. 30, Blunt said. Members covered by Anthem's employer-based and individual health plans are not impacted. According to Anthem's website, it will honor and cover previously approved authorizations to Mercy Health facilities at the agreed upon rate before termination as part of the transition of care process. Patients will continue to have access to Mercy Health hospitals in cases of emergency treatment, regardless of the network status with Anthem, according to Mercy Health.