Mercy Health, Anthem Come to Short-Term Understanding

YOUNGSTOWN, Ohio – Bon Secours Mercy Health and Elevance Health, parent company of Anthem Blue Cross and Blue Shield in Ohio, reportedly reached an understanding to allow Anthem Medicaid members access to continued care at Mercy Health, at least in the short term.

A deadline passed on June 30 for a negotiated agreement between the insurance provider and Mercy, which operates three hospitals and several satellite clinics in the Mahoning Valley region.

According to Anthem spokesman Jeff Blunt, Anthem and Mercy on Monday reached an understanding to allow Anthem’s Medicaid members to continue care through Mercy Health doctors and hospitals through standard out-of-network reimbursement for a transition period of no less than 90 days.

However, Mercy Health spokeswoman Jennifer Robinson said Mercy Health notified the state of Ohio on Monday that the health care system would continue to see Anthem Medicaid patients through July 31 to give patients enough time to switch plans. According to Robinson, Mercy did not commit to another specific length of time or end date.

Robinson is suggesting during this time, patients with Anthem Ohio Managed Medicaid should call the Ohio Office of Medicaid at 800 324 8680 to initiate a Just Cause transfer to an alternative managed Medicaid plan, which are all currently contracted with Mercy Health.

It was noted that all patients, regardless of their network status with Anthem, continue to have access to all Mercy Health hospitals in case of emergency treatment.

According to Mercy Health, the negotiations have occurred due to a 6.8% increase in the cost of care, brought on by inflation, labor and supply cost challenges. Mercy Health also alleges late and unpaid claims by Anthem totaling $100 million.

Blunt has said the current contract had 18 months remaining when Mercy Health attempted to renegotiate, and instead of requesting a payment increase for Medicaid members, the health care system attempted to force higher costs on employer-based and individual plan members.

Published by The Business Journal, Youngstown, Ohio.