Anthem Blue Cross Blue Shield of Virginia has filed a cease and desist order against Cincinnati-based Bon Secours Mercy Health for allegedly denying access to Anthem's Medicaid patients amid a tense reimbursement rate dispute between the organizations, ABC affiliate WRIC reported Aug. 22.
Since Aug. 1, 11,000 Anthem Medicare Advantage members in Virginia have not had access to Bon Secours facilities, along with nearly 50,000 Anthem Medicaid beneficiaries in Ohio. Anthem's Medicare Advantage members in Ohio and Kentucky will be out of network with a majority of Bon Secours facilities by October.
In Virginia, Bon Secours is in network with Anthem's Medicaid plan until October as well, but the payer told WRIC there already have been issues with Medicaid members accessing care at BSMH facilities.
"We received some of those members calling us; they're telling us that Bon Secours facilities are telling them they can't get care at their facility, or their care is being disrupted because they are no longer in network," Anthem Virginia President Monica Schmude said. "If you are a Medicaid member or you're a commercial member through your employer, you absolutely have access to care."
A Bon Secours spokesperson told WRIC that Anthem's claims are "unfounded and false."
Commercial, Medicaid and Medicare contracts between the organizations were set to expire at the end of 2024, but BSMH wrote on its website that "current reimbursement rates from Anthem have not kept pace with rising costs of labor, supplies and medications," leading it to drop Anthem Medicaid and Medicare members. Negotiations started about a year ago and BSMH says they have now stalled entirely. A spokesperson for the system previously told Becker's it is seeking higher reimbursement rates from all Anthem plans besides Medicaid.
"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," an Elevance Health spokesperson previously told Becker's.
Elevance Health is the parent company of 14 Anthem Blue Cross Blue Shield plans.