Mercy Health Advises Anthem Medicaid Patients to Switch Plans

YOUNGSTOWN, Ohio – Mercy Health is offering guidance on how Anthem Ohio Managed Medicaid patients can switch plans.

Mercy Health became out of network for Anthem Managed Medicaid members in Ohio on July 1.

Mercy Health is advising patients with Anthem to call the Ohio Office of Medicaid at 800 324 8680 to initiate a Just Cause transfer to one of the six alternative managed Medicaid plans that are currently contracted with Mercy Health.

“Mercy Health remains disappointed that Anthem continues to mislead their members by failing to update its provider directory noting that Mercy Health is no longer in Anthem’s Managed Medicaid network, falsely giving the impression that Mercy Health remains in-network,” Mercy Health said in a news release Wednesday. “Additionally, Mercy Health has received feedback from patients that upon inquiry to Anthem, Anthem has been inaccurately informing patients that there is no need to change health plans as Mercy Health remains contracted with Anthem.”

Mercy Health and Elevance Health, parent company of Anthem Blue Cross and Blue Shield in Ohio, were unable to reach a deal on a new contract.

Mercy Health spokeswoman Kara Franz said in a statement last month that without an agreement, nearly 50,000 Ohioans, including 3,541 in Youngstown, stood to lose their Medicaid insurance coverage with Mercy Health.

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 Franz claimed Elevance rescinded its most recent offer and discontinued negotiations.

“Mercy Health’s current contracts with Anthem have not kept pace with the rising cost of labor, supplies and medications, undermining our ability to provide care now and into the future,” Mercy Health said in Wednesday’s release. “This while Anthem, once again, posted a Q2 2023 earnings statement, released on July 19, that showed a YTD operating income of $5.5B, a 14.4% increase from the same period in 2022.”

Anthem spokesman Jeff Blunt last month denied that the insurance company left the negotiating table and said Anthem was continuing to advocate solutions, which would not include terminating contracts for vulnerable populations. He said Mercy Health was 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.

Mercy Health has reached out to the Ohio Department of Medicaid to ask for:

  • Reassignment of all 50,000 Anthem Managed Medicaid beneficiaries who have seen a Mercy Health provider in the past 12 months.
  • Enrollment freeze on Anthem so no new individuals can enroll without understanding Mercy Health is no longer participating with Anthem.
  • Special open enrollment period so anyone can switch.
  • Investigating Anthem’s lack of network adequacy for Youngstown and Lima areas.

Published by The Business Journal, Youngstown, Ohio.