Anthem Blue Cross and Blue Shield and Bon Secours Mercy Health have put aside their differences and reached a contract agreement just days before the provider was set to go out-of-network for Anthem's Medicaid members in Virginia.
The two reached a "multi-year" arrangement, according to an announcement issued Friday, that extends across all of Bon Secours' facilities in Ohio, Kentucky and Virginia. It will keep Bon Secours in-network for Anthem members until at least 2028.
As the dispute dragged on, Bon Secours went out-of-network for Medicare Advantage enrollees in Virginia on Aug. 1 as well as for Medicaid members in Ohio on July 1. Anthem will cover claims that members may have occurred during that out-of-network period, according to the announcement.
As part of the agreement, Bon Secours will toss a lawsuit filed in late August aiming to recover more than $90 million in allegedly unpaid claims. In addition, the two will form collaborative teams "to address claims submissions and payment processes."
“I’m proud that both organizations continued to focus on our shared priority: the communities we serve,” said Anthem Virginia President Monica Schmude in the release. “We worked together to creatively address affordability for our members and the financial needs of an important care provider. This agreement provides long-term stable access to care at Bon Secours Mercy Health without cost increases for our members and employers.”
Bon Secours posted a notice on its website in June that it was at a standstill with the insurer as its reimbursement rates are "not sustainable nor market competitive." The health system said it was receiving far less from Anthem plans than it was from other insurers in the market.
This culminated in the August lawsuit, a move Schmude said was "unprecedented" in an interview with Fierce Healthcare.
Don Kline, chief operating officer for Bon Secours Mercy Health, said in the release that the new agreement "protects our patients’ access to compassionate care close to home.”
“We understand that being out of network can be very difficult, and we are pleased that patients with Anthem insurance can now see our physicians and use our hospitals at an in-network cost,” Kline said. “We sincerely believe that access to quality health care services is vital for our communities.