Bon Secours Mercy Health is sparring with Anthem Blue Cross and Blue Shield over reimbursement, the latest acrimonious contract negotiation to go public.
The Ohio-based health system posted a notice on its website that the rates Anthem pays its doctors, nurses and other providers are "not sustainable nor market competitive." Bon Secours said the insurer's rates are "substantially less" than it receives from other payers and have failed to keep up with inflation and labor costs.
In the statement, the system said that it is "not the only one shouldering the burden of Elevance Health’s (Anthem) practices." Regional Anthem plans operate in separate markets, while Elevance Health is the broader corporate brand.
"Patients and employers often have lengthy delays before receiving clear explanation of their benefits and associated costs," Bon Secours wrote. "This often results in patients receiving final statements months to years after services have been provided."
In a statement to Fierce Healthcare, the Ohio Anthem BCBS plan said that Bon Secours informed it that the system will no longer accept its Medicaid members after July 1 "unless we agree to pay significantly higher reimbursement rates for our employer-sponsored and individual health plans."
The decision was made despite the fact that the two have a contract in place through 2024, Anthem said.
"If we were to agree to their requests for higher rates, on top of the reasonable increases we are already providing under the current contract, the result would be higher costs borne directly by businesses and individuals," the insurer said.
An Anthem plan is also involved in similarly heated discussions over reimbursement with Carbon Health, a California-based startup provider. It's rare for payer-provider contract negotiations to go public, but providers have faced significant financial hardship in the wake of COVID-19, inflation and ongoing labor shortages and are looking to pour on the pressure to secure higher rates.
In the notice, Bon Secours said its patients should continue to see their regular physicians for now, and, if the visit ends up being out-of-network, the system will address the patients' options at that time. The system also urged Anthem members to call the insurer and pressure it keep Bon Secours in-network.
Anthem said it will promote access by ensuring its members can find an array of providers in its network.
"Anthem remains committed to our members and through our broad network of care providers, we will ensure that all of our members have access to the care they need," the insurer said.