Bon Secours Mercy Health is dropping Anthem/Blue Cross Blue Shield’s managed Medicare plans as they couldn’t agree on reimbursement rates. Around 6,000 Medicare users in Hampton Roads will be out of network, necessitating new providers or out-of-pocket payments. The insurance company’s Medicaid plans remain in-network until September but may lapse without resolution. Anthem members with employer or ACA marketplace coverage are unaffected. Bon Secours blames inadequate reimbursement rates, while Anthem claims it’s a negotiation tactic. Negotiations with Mid-Atlantic Women’s Care are ongoing.
Bon Secours Mercy Health has decided to withdraw from Anthem/Blue Cross Blue Shield’s managed Medicare plans due to an inability to reach an agreement on reimbursement rates. As a result, approximately 6,000 residents in Hampton Roads who rely on Medicare will be out of network starting from Tuesday.
Individuals with Anthem/BCBS-managed Medicare plans and who currently receive medical services from Bon Secours Mercy Health will need to either find new providers or bear the expenses out of pocket. It’s worth noting that the insurance company’s Medicaid plans will remain in-network at Bon Secours until the end of September unless the negotiations are resolved before that.
However, those who have Anthem/BCBS health insurance through their employer or the Affordable Care Act marketplace will not be affected by this change.
There are exceptions in place for certain cases, such as continuity of care during pregnancy and other medically delicate conditions, which will allow patients to continue being covered by their current providers, according to Anthem spokeswoman Kersha Cartwright.
Impacted individuals have been notified about their options through a letter, and they can also reach out to the member services number on their insurance cards or visit the Anthem website for more information.
In another unrelated contract situation, Anthem’s agreement with Mid-Atlantic Women’s Care, consisting of 19 OB-GYN practices in Virginia, is also set to expire soon, but negotiations are ongoing.
Bon Secours has expressed its dissatisfaction with the reimbursement rates offered by Anthem/BCBS, stating that they are not competitive or in line with market standards. They claim that the current rates do not adequately cover inflation or labor costs, making it challenging to provide safe and quality care.
Anthem, on the other hand, maintains that Bon Secours’ decision to terminate the plans is part of their negotiating strategy, and they have urged the health provider to reconsider to prevent care disruption for vulnerable populations. Anthem contends that Bon Secours requested a significant increase in reimbursement rates, seeking to triple the current amounts during the negotiations that began in October.
In a recent announcement, Bon Secours Healthcare revealed its decision to withdraw from Anthem-managed Medicare plans, impacting thousands of Medicare beneficiaries across the region. This move comes after failed negotiations between Bon Secours and Anthem regarding reimbursement rates and contract terms. The withdrawal will result in changes to provider networks and coverage options for affected individuals, prompting concerns among many seniors reliant on Bon Secours for healthcare services. While Bon Secours assures patients that existing appointments and treatments will be honored, Anthem members are advised to review their plan options carefully and explore alternative healthcare providers to ensure uninterrupted access to care. Anthem has also committed to assisting members affected by the change, offering guidance and support throughout the transition process. The announcement underscores the complexities of healthcare contracting and highlights the ongoing challenges faced by both providers and insurers in delivering quality care while managing costs.