Mercy and Anthem reach coverage agreement, avoid removing thousands from network - Insurance News

The Chesterfield-based health system, Mercy, will cover Anthem patients in Missouri in 2025. The two companies announced Wednesday that they had reached an agreement months after the health system threatened to stop accepting Missouri patients covered by health insurance from January 1.

Under the new contract, Anthem Customers who have plans through their employer, Medicare Advantage or the Affordable Care Act Marketplace will maintain their coverage for care at Mercy, which operates dozens of hospitals and hundreds of outpatient clinics nationwide. Missouri, Arkansas, Kansas and other states.

Health systems and insurers regularly negotiate contracts that set the amount insurers pay hospitals and other providers for surgeries, tests and other services. The details of these negotiations are generally private and the two companies have not disclosed further information about the contract.

Representatives of Anthem and Mercy declined interview requests.

Anthem in September, officials said Mercy was charging too much money to cover the procedures. Those responsible for Miséricorde affirmed Anthem imposed onerous requirements on providers, such as requiring the insurer to authorize certain care.

Mercy officials then said the abandonment Anthem-covered patients could have reached half a million people in the state who receive care at health system facilities.

Insurance industry analysts say health systems with large patient populations or many sites can leverage that size to negotiate higher reimbursement rates. Similarly, large insurers can leverage their large patient networks to pay less expensive reimbursements to health systems.

As health systems have grown and mergers between hospital companies have become more common, hospitals have more leverage in negotiating rates with insurers, policy analysts say.

A lot of AnthemPatients are enrolled in employer benefit plans, said Laurel Pickeringpresident and CEO of St. Louis Area Business Health Coalitiona nonprofit organization that represents Anheuser-Busch, Boeing, school districts and other employers.

Companies often enroll their employees in benefits on an annual basis, with new plans starting in January, she said.

“Decisions need to be made by late summer and early fall, and this conflict started in September,” Pickering said. “It was simply too late to make changes…Employers are concerned and they are breathing a sigh of relief.”

Pickering said the public is more aware of the negotiations between the companies than in the past because Mercy sent a notice to patients earlier in the year warning them of potential fallout from those negotiations. Anthem.

“Patients and staff have been engaged in a way I’ve never seen before,” she said. “A new element is the patient voice and the employee voice.”

Patients are worried and unsure if they will have coverage in the new year, said Joe Bottani of St. Louis-based on Arch Brokerage, which helps individuals and employers choose health insurance plans.

“There really has been a lot of frustration and confusion, and all for nothing at this point,” he said. “People had to make decisions and really think about how important doctors were and how willing they were to, you know, defer to insurance.”

Bottani said he has seen many patients, particularly those who purchased coverage on the federal health insurance marketplace, give up Anthem and switch to different insurers as a precaution.

“I think the patients are probably the ones who have lost the most here,” he said.

This story has been updated to include comments from company representatives who work with Anthem customers.