Nearly 50,000 Medicaid enrollees in Ohio are caught in the middle of a commercial reimbursement fight between Anthem Blue Cross Blue Shield and Cincinnati-based Bon Secours Mercy Health.
An in-network contract between the organizations for Medicaid managed care members was terminated July 1, but beneficiaries have access to Bon Secours Mercy facilities through the end of July.
An Anthem spokesperson previously told Becker's that BSMH terminated the original contract, which ran through 2024. The payer also said BSMH is using Ohio Medicaid members to obtain higher commercial rates from Anthem, which would lead to higher premiums if agreed upon.
"We have repeatedly requested that Bon Secours Mercy Health rescind their termination of the current contract, an action which threatens to put society's most vulnerable at risk in order to leverage higher revenues from Anthem. Unfortunately, they have refused to do so," the spokesperson said.
On its website, Bon Secours Mercy alleged that what Anthem currently pays physicians, nurses and other providers is "not sustainable or market competitive."
"It's unfortunate that this is the current situation; however, we promise to continue doing our part and work hard, in good faith, to reach a new agreement with Elevance Health with a clear understanding that it takes two parties working hand in hand to reach a resolution," a BSMH spokesperson told Becker's in June. "Elevance Health has discontinued current negotiations, and while that is disappointing, we remain committed to compassionately serving every patient who walks through our doors."
Elevance Health is the parent company of 14 Anthem Blue Cross Blue Shield affiliates. BSMH also said Anthem plans owe the health system more than $100 million for late and unpaid claims.
In addition to Ohio Medicaid members, the Anthem spokesperson said its Medicaid managed care plan in Virginia will be out of network with BSMH by Sept. 1. For Medicare Advantage, 19,000 Anthem members in Virginia will be out of network with BSMH by Aug. 1, and Anthem MA members in Ohio and Kentucky will be out of network by Oct. 1.