Anthem Medicaid members in Ohio can receive care at Mercy Health hospitals for a transitional period of at least 90 days, following the expiration of their contract. Although Mercy Health sought higher reimbursements from Anthem, the two parties have reached an understanding to avoid disruptions in care. Emergency treatment will still be available to all patients at Mercy Health hospitals, regardless of their network status with Anthem. The termination of the contract is expected to impact around 40,000 patients in Ohio.
Anthem Medicaid members in Ohio have been given 90 days to receive care at Mercy Health’s hospitals, despite the expiration of their contract. Anthem Blue Cross Blue Shield and Mercy Health have reached an understanding to ensure uninterrupted care for affected individuals.
The terminated contract between Anthem and Mercy Health expired recently, but representatives from both organizations assure that Medicaid members can still receive care without any disruptions, at least for the time being.
It’s important to note that Mercy Hospital in Canton is not affiliated with Mercy Health and is part of the Cleveland Clinic health system. Additionally, a Mercy Health auxiliary owned a portion of Summa Health until 2021 when the agreement ended.
Anthem spokesman Jeff Blunt explained that to prevent care disruption for Anthem Medicaid members in Ohio, an understanding has been reached between Anthem and Mercy Health. This agreement allows Medicaid members to continue receiving care from Mercy Health doctors and hospitals through standard out-of-network reimbursement for a transition period of at least 90 days. This means that prior-authorization requirements remain in place, but no special out-of-network authorization is necessary for continued care at Mercy Health during their exit from the Medicaid provider network. The goal is to ensure that this vulnerable population faces no interruptions in their care.
Similarly, Mercy Health has emphasized that patients can still access care at their hospitals in Ohio, despite the ongoing dispute over fair reimbursement rates.
Amid the disagreement between Mercy Health and Anthem, Medicaid members found themselves caught in the middle. Mercy Health decided to terminate its Managed Medicaid contract with Anthem, citing increased labor and operating costs. They sought higher reimbursements from Anthem to address the financial challenges they were facing.
Brian Gwyn, Mercy Health’s Cincinnati market president, expressed dissatisfaction with the payment they were receiving, stating that they felt significantly underpaid for the services provided. Mercy Health believed the proposed numbers from Anthem were unacceptable and did not reflect the actual costs incurred. They argued that Anthem was making substantial profits without adequately compensating the healthcare providers.
However, Anthem maintained that Mercy Health should honor the existing contract and renegotiate when it was originally set to expire in early 2025. Anthem also expressed unwillingness to accept reimbursement rates that exceeded the current hospital inflation rate by threefold.
An estimated 40,000 patients in Ohio are expected to be affected by the termination of the contract between Mercy Health and Anthem. Despite this, Mercy Health has assured that all patients, regardless of network status with Anthem, will still have access to their hospitals in cases of emergency treatment.