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Medicaid members who use Anthem Blue Cross Blue Shield for insurance coverage can proceed to obtain care at Bon Secours Mercy Health hospitals in Ohio underneath a 90-day transitional “understanding” between the 2 events.
A terminated contract between the 2 expired early Saturday with out renewal, however representatives from Mercy Health and Anthem each say these affected can nonetheless get care with none disruptions, for now.
Mercy Hospital in Canton is a part of the Cleveland Clinic well being system and is not affiliated with Mercy Health. An auxiliary of Mercy Health owned 30% of Akron-based Summa Health till that deal led to 2021.
“To avoid care disruption for Anthem Medicaid members in Ohio, Anthem and Mercy Health have reached an understanding to allow our Medicaid members to continue care at Mercy Health doctors and hospitals through standard out-of-network reimbursement for a transition period of no less than 90 days,” Anthem spokesman Jeff Blunt wrote in an assertion. “This means that continuing care at Mercy Health requires no special out-of-network authorization, beyond typical prior-authorization requirements, to ensure that this vulnerable population will have no disruption in care during Mercy’s exit from the Medicaid provider network.”
Mercy Health, equally, has insisted sufferers can nonetheless obtain care at Ohio hospitals regardless of the dispute over truthful reimbursement charges.
Mercy Health-Anthem dispute:Ohioans prepare to lose Anthem Medicaid at Mercy hospitals
“All patients will continue to have access to all Mercy Health hospitals in cases of emergency treatment, regardless of the network status with Anthem,” the well being system wrote on its web site.
How Medicaid members obtained caught in the midst of a dispute between Mercy Health and Anthem
Citing elevated labor and working prices, Mercy Health moved to terminate a Managed Medicaid contract it had with Anthem until the insurance coverage firm agreed to greater reimbursements Mercy deemed truthful given the inflationary squeeze they’ve confronted.
“We feel like we’re being drastically underpaid for the services we’re providing,” Brian Gwyn, Mercy Health’s Cincinnati market president, beforehand mentioned. “What they’re proposing is unacceptable. It’s laughable to look at those numbers that they’re asking for. We know that they are making a lot of money and they’re not passing that through to the actual provider that’s doing the work.”
Anthem nonetheless, insisted Mercy Health honor a contract between the 2 and renegotiate when it was initially set to run out in early 2025. The firm additionally mentioned it wasn’t keen to conform to “rates that are three times the current hospital inflation rate.”
“Mercy Health is not seeking increased payment for our Medicaid members, they are terminating their contract to serve this vulnerable population in an attempt to force higher costs on our employer-based and individual plan members,” Blunt mentioned in earlier assertion.
The contract termination is anticipated to have an effect on an estimated 40,000 sufferers in Ohio.
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