Impasse with insurer could lead to added costs
Published 6:13 pm Friday, July 21, 2023
Both Bon Secours and Mid-Atlantic Women’s Care have issued news releases recently to advise patients that agreements between the organizations and Anthem Blue Cross Blue Shield are set to terminate effective Tuesday, Aug. 1, which could lead to more out-of-pocket costs for those seeking medical care.
In reference to a current disagreement between Bon Secours and Anthem BCBS, Bon Secours Mercy Health Public Relations and Communication Director Emma Swann made clear that only patients in Virginia with Anthem Medicare Advantage as their primary insurance would be impacted.
“Patients in Virginia with Anthem employer-provided plans, plans purchased directly from Anthem, or those patients with Anthem Medicaid are not impacted,” she said.
In a July 13 release, Bon Secours noted that it and Anthem BCBS, otherwise known as Elevance Health, have been in negotiations since last October, affecting the Medicare Advantage contract in Virginia, among others.
“Unfortunately, negotiations with Anthem remain at an impasse,” Bon Secours officials stated. “If Bon Secours is not able to reach an agreement beforehand, our Medicare Advantage contract with Anthem in Virginia will terminate effective Aug. 1, and Bon Secours nurses, doctors and caregivers will be considered out-of-network for nearly 19,000 patients who have Anthem Medicare Advantage health insurance.”
The release noted that this could mean that patients with Medicare Advantage insurance would have to pay more out-of-pocket to continue seeing their Bon Secours providers.
Bon Secours officials described this situation as “incredibly disheartening.”
“What Anthem BCBS pays our doctors, nurses and other caregivers is not equitable or market competitive,” the officials stated. “Their current reimbursement rates — which are substantially less than those we receive from other payer partners in the market — have not kept up with inflation or labor costs and are overwhelmingly inadequate to account for the cost of providing safe and quality care.”
The release did make a point to state that access to Bon Secours Emergency Department facilities will always be available at no higher out-of-pocket cost to patients for covered emergency services, regardless of network status.
“Bon Secours patients with Anthem Medicare Advantage coverage are encouraged to make their voices heard,” Bon Secours officials stated.
Swann noted that the Medicare open enrollment period is from Oct. 15-Dec. 7.
Patients should talk to their brokers or call the Centers of Medicare & Medicaid at 1-800-633-4227 to understand options about plans that keep their Bon Secours providers in-network, the release stated.
“Bon Secours remains in-network with all other major Medicare Advantage health plans in Virginia,” Bon Secours officials stated in the release. “Patients are also encouraged to call Anthem at the number on the back of their insurance cards and tell them how important it is to keep uninterrupted in-network access to Bon Secours.”
Swann said that patients will be able to switch Medicare Advantage plans during the open enrollment period, and patients with Medicare Advantage Preferred Provider Organization plans may elect to continue seeing Bon Secours providers.
“Certain patients may be eligible for a special enrollment period prior to the annual enrollment period, however it is likely the majority will be required to change health plans during the annual enrollment period,” Swann said.
Changes made during the annual enrollment period will go into effect Jan. 1, 2024.
Swann was asked the following: If no agreement is reached between Bon Secours and Anthem/Elevance Health by Aug. 1, is there any way — without leaving their Bon Secours providers — that those 19,000 patients referenced can avoid paying more out of pocket prior to a switch in plans that would not go into effect until Jan. 1, 2024?
In reply, she said, “Patients should call Anthem BCBS before any scheduled appointments to apply for Continuity of Care.”
She noted that without a Continuity of Care authorization from Anthem BCBS, Bon Secours will be unable to schedule appointments for patients with Anthem BCBS’s Medicare Advantage Health Maintenance Organization health insurance on or after Aug. 1.
“Certain conditions, such as care for chronic or complex illnesses, may be eligible for Continuity of Care, which would provide approved patients the opportunity to continue seeing their current care team at in-network rates, even if Bon Secours is out of network with Anthem BCBS,” she said. “Patients must seek Continuity of Care approval from Anthem BCBS. Anthem BCBS alone will decide whether to approve or deny the patient’s request.”
Echoing the July 13 release, she said that access to Bon Secours Emergency Department facilities will always be available at no higher out-of-pocket cost to patients for covered emergency services, regardless of network status.
“Patients with Medicare Advantage PPO benefits may elect to continue to see Bon Secours providers,” she said. “However they may experience a higher out-of-pocket cost depending on their Anthem Medicare Advantage benefits.”
In its July 13 release, Bon Secours noted that it is committed to providing regular updates on its discussions with Anthem/Elevance Health at bonsecours.com/elevancehealth and will be communicating directly with those who may be impacted.
MID-ATLANTIC WOMEN’S CARE
Mid-Atlantic Women’s Care, a collective of more than 70 physicians described as the premier OB/GYN group in Hampton Roads, announced Wednesday, July 12, that its agreement with Anthem BCBS is set to terminate effective Aug. 1.
“In recent months, Mid-Atlantic Women’s Care has been in active discussions with Anthem BCBS about renewing its contract,” group officials stated in the July 12 release. “To date, the two organizations have been unable to arrive at a mutual agreement.”
If an agreement is not reached by July 31, the agreement between the parties will terminate, resulting in more than thousands of area patients losing their current women’s health care provider, the release noted. M-AWC patients have been notified about the status of these negotiations.
“Mid-Atlantic Women’s Care providers are committed to providing the best care possible and minimizing the disruption this event will have on its impacted patients,” said Dr. Tom Basco, M-AWC’s medical director.
The release stated that Anthem BCBS member patients who are currently pregnant, undergoing a course of treatment, or have a surgery scheduled, may still be able to visit their Mid-Atlantic Women’s Care office and provider as an in-network provider until delivery and postpartum care is completed.
“To do so, each patient will need to request Continuity of Care and is encouraged to reach out to their provider’s office for assistance,” officials said in the release.
Well-woman exams and routine office visits unrelated to pregnancy or surgery are not eligible for Continuity of Care according to Anthem BCBS, the release noted.
“These patients may continue to see their provider for their scheduled visit, but an out-of-network cost may apply,” officials stated.
Basco said, “Mid-Atlantic Women’s Care is hopeful to reach mutual agreement with Anthem BCBS that allows it to remain in-network with Anthem BCBS prior to the termination date. Meanwhile, we are committed to continued development of payor partnerships.”
M-AWC officials indicated that impacted patients are encouraged to contact their providers through the patient portal for additional details or assistance.
Then the release provided a list of impacted practices, which included the following:
- Center for Women’s Health;
- Chesapeake Women’s Care;
- Complete Women’s Care;
- Gynecology Specialists;
- Harrisonburg OBGYN;
- Mid-Atlantic Imaging Centers;
- Obstetrics & Gynecology Associates of Hampton;
- Peninsula Women’s Care;
- Physicians to Women Inc.;
- Specialists for Women;
- The Group for Women;
- Tidewater Physicians for Women;
- Total Care for Women;
- Virginia Beach Obstetrics & Gynecology;
- Virginia Center for Women;
- West End Obstetrics & Gynecology;
- Williamsburg Obstetrics; and
- About Mid-Atlantic Women’s Care.
For more information, visit www.midatlanticwomenscare.com.