Bon Secours Mercy, Anthem BCBS plans spar over reimbursement rates

Cincinnati-based Bon Secours Mercy Health and several Anthem Blue Cross Blue Shield plans are at odds over commercial reimbursement rates that could affect coverage for individuals enrolled in Medicaid managed care and Medicare Advantage plans. 

On its website, Bon Secours Mercy alleged that what Anthem currently pays physicians, nurses and other caregivers is "not sustainable or market competitive." 

"Their current reimbursement rates — which are substantially less than those we receive from other payer partners in the market — have not kept up with inflation or labor costs and are overwhelmingly inadequate to account for the cost of providing safe and quality care," the health system wrote. 

BSMH also claimed that Anthem owes the health system more than $100 million for late and unpaid claims and that the payer has discontinued current contract negotiations. BSMH is also encouraging its patients to contact Anthem about the issue directly.

"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 June 8. "Elevance Health has discontinued current negotiations, and while that is disappointing, we remain committed to compassionately serving every patient who walks through our doors."

In response, a spokesperson for Anthem BCBS told Becker's in a June 7 statement that if the insurer were to "agree to their requests for higher rates, on top of the reasonable increases we are already providing under the current contracts, the result would be higher costs borne directly by businesses and individuals." 

The Anthem BCBS spokesperson said BSMH terminated the current contract, which runs through 2024. The payer also claimed that BSMH has threatened to stop accepting Anthem BCBS Medicaid or Medicare members in Ohio, Kentucky and Virginia unless Anthem agrees to pay higher commercial rates.

Specifically, the Anthem BCBS spokesperson said its Medicaid managed care plan in Ohio will be out of network with the health system on July 1, and its Virginia Medicaid plan will be out of network by September 1.

For Medicare Advantage, Anthem BCBS members in Virginia will be out of network with BSMH by August 1, and Anthem BCBS members in Ohio and Kentucky will be out of network by October 1.

"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 Anthem BCBS spokesperson said.

Elevance Health is the parent company for 14 Anthem Blue Cross Blue Shield affiliates.

Editor's Note: This article was originally published May 25 and only included information regarding contract negotiations between Bon Secours Mercy Health and Anthem Blue Cross Blue Shield in Ohio. The article and its headline have been updated to reflect new information from the two organizations.

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