Bon Secours Mercy Health and Anthem Blue Cross Blue Shield have resolved their contract dispute, reinstating in-network status for 11,000 Virginians with Medicare Advantage plans and 39,000 with managed Medicaid plans. The agreement, announced on Friday, addresses reimbursement rate disagreements and ensures coverage for patients at Bon Secours facilities. Anthem will cover claims for the period Bon Secours was out of network, and both parties will collaborate on claims submissions and payments.
Bon Secours Mercy Health and Anthem Blue Cross Blue Shield have resolved their long-standing contract dispute, which disrupted healthcare services for 11,000 Virginians. The agreement, announced on Friday, restores in-network status for patients with Medicare Advantage plans through Anthem at Bon Secours facilities in Richmond, Newport News, Suffolk, and Kilmarnock. Since August 1, these patients had been considered out of network. Additionally, starting October 1, 39,000 Virginians with managed Medicaid plans through Anthem will maintain their in-network coverage at Bon Secours.
Both companies emphasized the importance of affordable healthcare access. The specifics of the agreement, including the resolution of reimbursement rates, remain confidential. As part of the deal, Anthem will cover claims for Medicare Advantage patients who received care from Bon Secours during the period it was out of network. Bon Secours has agreed to drop a lawsuit it filed against Anthem in Henrico Circuit Court concerning alleged payment issues in Virginia. The resolution also includes collaborative efforts between the two entities to address claims submissions and payment processes.
The dispute primarily revolved around reimbursement rates, the payments made by insurance companies to healthcare providers. Anthem claimed that Bon Secours requested double-digit rate increases during an ongoing three-year contract, leading to the termination of in-network coverage for patients with Medicare Advantage plans. Bon Secours argued that Anthem’s payments were significantly lower than those from other insurers and accused Anthem of withholding millions in late and unpaid claims.
