Anthem Blue Cross Blue Shield and Bon Secours Mercy Health have resolved their publicized reimbursement dispute by reaching a contract agreement extending until 2028. The deal covers all Bon Secours Mercy Health facilities in Ohio, Virginia, and Kentucky for various Anthem members. Anthem will also reimburse claims submitted during the out-of-network period. This resolution ends a contentious legal battle, initiated when Anthem Virginia alleged improper care access denial, and Bon Secours claimed $93 million in unpaid claims, now dismissed with the contract agreement.
Anthem Blue Cross Blue Shield and Bon Secours Mercy Health, based in Cincinnati, have resolved their long-standing dispute over reimbursement terms. This marks the end of a highly publicized disagreement between the payer and provider in 2023.
Under the newly established contract, which extends until 2028, Anthem Blue Cross and Blue Shield will cover services provided by Bon Secours Mercy Health facilities, including hospitals, outpatient care centers, and physician offices, across Ohio, Virginia, and Kentucky. This coverage applies to members of Anthem Medicare Advantage, Medicaid, employer-sponsored plans, and exchange plans, as announced in a news release on September 29th, shared with Becker’s.
In addition to the contract resolution, Anthem has also committed to reimbursing any claims submitted by patients during the period when the two organizations were not in-network. This includes claims from Anthem Medicare Advantage plans in Virginia and Anthem Medicaid in Ohio.
The dispute between the two entities had escalated earlier in the year when Anthem Virginia issued a cease and desist order against Bon Secours, alleging that Medicaid beneficiaries were being improperly denied access to care. Subsequently, Bon Secours filed a lawsuit against Anthem Virginia, claiming $93 million in unpaid claims. With the new contract agreement in place, this lawsuit is now being dismissed, bringing an end to their bitter dispute.
