Mercy Health Notifies Patients of Possible Coverage Change

YOUNGSTOWN, Ohio – As of Oct. 1, Mercy Health may be out-of-network for Medicare Advantage patients in Ohio following months of negotiations with Elevance Health (Anthem).

Mercy Health on Thursday announced the proposed change so patients can switch to another Medicare plan ahead of the current deadline.

This announcement comes after the July 1 notification that left those with Anthem Ohio Managed Medicaid plans also out-of-network at Mercy Health hospitals and providers throughout the Mahoning Valley.

Jeff Blunt, Anthem’s corporate communications director, said Mercy Health chose to terminate the contract, which was set to expire Jan. 1, 2025, and already included annual increases to account for inflation and labor costs. Blunt claims the amount Mercy Health is currently demanding is three times the inflation rate.

Bon Secours Mercy Health claims significant inflation in the areas of labor and supply costs, leading to significant health system operating losses despite operational cuts.

“For more than a century, Mercy Health has compassionately cared for the people of the Mahoning Valley, especially those who are poor, dying and underserved. We believe every patient deserves access to high-quality care and the providers they know and trust,” said Dr. John Luellen, president of Mercy Health Lorain and Youngstown. “Anthem’s refusal to reimburse the full cost of care to Mercy Health while simultaneously bringing in record profits, paid for by patients and employers, is unconscionable. We implore Anthem to return to the negotiation table to resolve this issue.”

Mercy Health reports Anthem had operating revenue of $43.4 billion, a growth of 12.7% last month year-over-year. Mercy also claims Anthem has refused to pay for more than $100 million in services already provided to patients covered under their plans and has conducted nearly triple the rate of historic audits in recent months to increase the administrative burden of the hospital.

Mercy Health is suggesting patients call the Centers for Medicare and Medicaid Services to explore their options for changing to a different plan and stay with their system.

Blunt said due to the refusal by Mercy Health to accept Anthem Medicare Advance coverage, the insurance company is assisting members to transition to elective care at one of the many high quality health systems remaining in the network. Additionally, Blunt said Anthem will assist members who require continued care with their current provider for certain serious and complex conditions.

“We have repeatedly asked Mercy Health to rescind this termination and protect Medicare Advantage and Medicaid members in a dispute over pricing in a completely different line of business,” Blunt said. “They are needlessly disrupting care for thousands of vulnerable people as a negotiating tactic to force higher prices on people covered through their employers or the Affordable Care Act.”

Published by The Business Journal, Youngstown, Ohio.