Deadline Nears for Mercy Health, Elevance with No Deal in Sight

YOUNGSTOWN, Ohio – The deadline for reaching a deal regarding Medicaid insurance coverage between Bon Secours Mercy Health and Elevance Health, parent company of Anthem Blue Cross and Blue Shield in Ohio, ends Saturday, reportedly with no agreement in sight.

As a result, Mercy Health spokeswoman Kara Franz announced in a statement Thursday nearly 50,000 Ohioans, including 3,541 in Youngstown, may lose their Medicaid insurance coverage with Mercy Health beginning Saturday.

According to Franz, negotiations were conducted for nine months, but the two entities have failed to come to an agreement on rates. Franz claims Elevance recently rescinded its most recent offer and discontinued negotiations.

Jeff Blunt, spokesman for Anthem, denies the insurance company has left the negotiating table and said Anthem continues to advocate solutions, which would not include terminating contracts for vulnerable populations. Blunt said Bon Secours Mercy Health is choosing to cut off services for Medicaid and Medicare members in an attempt to force Anthem to agree to price hikes for those in the insurance company’s individual- and employer-based plans.

The renegotiation is reportedly coming mid-contract, and Blunt said Anthem remains hopeful Mercy Health will rescind the decision, honor the current contract and negotiate a new agreement at an appropriate time.

However, Mercy Health is reportedly facing significant inflationary challenges with labor costs increasing 9.6%, supply chain shortages and overall cost of care increases of 6.8% from 2021 to 2022. Franz claims Anthem owes Mercy Health more than $100 million in late and unpaid claims, while Blunt states despite Anthem working with Bon Secours Mercy Health, the health system has declined to provide additional information that would substantiate those claims.

“In the normal course of business, there is a lag in claims submission and payment as we perform our responsibility to assure claims are submitted and paid accurately,” Blunt said. “This is a critical role all health insurers play in the system. Over the last 12 months, 92% of claims are being processed within 14 days, and 98% within 30 days.

Blunt claims Mercy Health is providing inaccurate information to its patients about the process to obtain continued care with their current provider, which is handled by Single Case Agreements initiated by the hospital system. Mercy is urging patients with Elevance Health (Anthem) to call the number on the back of their insurance card and urge them to make patients and policyholders a priority.

Both sides publicly claim they want to continue negotiations.

“It is important that Elevance Health [Anthem] step up and support the care and well-being of its policyholders and the health care providers who care for them,” Franz said. “We are doing our part to serve our patients and communities, and we need Elevance Health to step up now and do theirs by offering sustainable, market-equitable rates and fair contract terms.”

Mercy Health operates local hospitals – St. Elizabeth in both Youngstown and Boardman, and St. Joseph Warren – and many satellite medical facilities in the Mahoning Valley. Bon Secours Mercy Health is part of a larger system of 1,200 care sites in seven states.

Pictured at top: Mercy Health – St. Elizabeth Youngstown Hospital.

Published by The Business Journal, Youngstown, Ohio.