11/25/2024
There's a whole lot of talk about the Anthem BCBS/Mercy contracting issue, so I'd like to share what I know. Most of this will be hearsay since only the people who know for sure what is going on are the people conducting the negotiations behind closed doors, but, most of what I know I have heard directly from sources inside Anthem and indirectly from sources inside Mercy administration.
First of all, if you are on a Medicare Supplement (Medigap) with Anthem, this whole thing does not apply to you. MedSupps are the one line of business with Anthem that this does not affect since you can go anywhere that accepts Medicare assignment. This really only applies to those on an individual plan through the Marketplace, off-exchange individual plans, Medicare Advantage plans, and group-health plans.
Officially, Mercy will not be in-network with Anthem BCBS for 2025. Unofficially, yes, they probably will be. Negotiations are ongoing and our Anthem sources are confident an agreement will be reached.
From what we understand, the group-health part of the contract is where the conflict is. They have already come to an agreement on both the under 65 individual plans and the Medicare Advantage lines of business, and they are close to an agreement on the group-health. The problem is, all lines of business are under one contract, so even though they have come to an agreement concerning the MA and individual plans, it won't do any good until they come to an agreement on the group-health.
We have had clients call and say they were notified from their Mercy doctor's office and that they would have to switch insurances or find a new doctor. Or, they checked the provider directories for Anthem and they could not find their doctor. This is all to be expected since technically the official word is that Anthem will not be in-network with Mercy for 2025.
Mercy aslo dropped Anthem for their own employee's health insurance in favor of United Healthcare. This, for those that have heard, is causing further alarm. I suspect that the contract dispute played some part in this, but I have a strong suspicion that this was mostly about premium dollars, and United Healthcare offered them a cheaper group rate. There is little loyalty in the group-health market, and if employers can save on employee healthcare premiums, they usually jump on it.
Anthem offered Mercy (n their terms) a generous 3-year contract, which Mercy rejected. Most of the time they have a 3- or 4-year contract cycle, so they renegotiate every few years. The only difference this year is it was made public by Mercy in what was probably a negotiation tactic. Mercy is going scorched-earth on Anthem on their website and Anthem is pointing the finger right back at them. The truth is probably somewhere in the middle, but this is making them both look bad. Mercy trying to strong-arm an insurance company into paying them more money seems to go against their claimed values as a non-profit.
They have until December 31st to sign a new contract, and to be honest, they may wait until the last minute to do so. At this point, it's all a battle of wills to see who can hold out the longest. Every hospital in the state is watching how this unfolds, and if Anthem gives in, even if they are in the wrong, hospital systems all over are going to see if they can get away with the same thing with the insurance companies they contract with. This will not be a good thing for the consumer.
The bottom line is this: 2.1 million people in the State of Missouri are affected by this contract dispute. There's no hospital system in MO with the infrastructure to handle the influx of patients they will receive if Mercy and Anthem don't make nice. This is, unfortunately, a classic case of two large corporations not having the best interest of the people that need them in mind. I don't know who is ultimately to blame, but I know people who work for both who are great people and care about the people they serve. Unfortunately, sometimes the big picture view from the top makes people forget about all of the little pictures at the bottom. All I know is that Mercy needs Anthem's money just as bad as Anthem needs Mercy's. Mercy is the largest provider in MO and Anthem is the second largest insurance carrier in the country, so the two can't afford to not do business with each other.
So what are your options?
If you are in a group-health plan, you are kind of stuck, because your employer makes those decisions for you.
If you are on a Marketplace plan, you have until December 15th to make a decision for a 1-1 effective date, or, January 15th for a 2-1 effective date.
If you are on a Medicare Advantage plan, you have a couple of options. You can hold out and wait and see what happens, but it is doubtful they will reach an agreement by the deadline of December 7th. You can always sign up for another plan and if they end up reaching a contract agreement, you have until December 31st to cancel your application, in which case you will stay on Anthem. You also have a second enrollment period after the first of the year, but the marketing guidelines on how much I'm allowed to say on here is sort of a gray area, so that's all I will disclose publicly. But, if you don't have any doctor appointments in January, that is an option.
I also would like to point out that I have skin in the game. I have Anthem through the Marketplace and I see Mercy docs. I am not switching my plan, that's how confident I am, based on inside information from Anthem, that they will reach an agreement.
Since this is on my business page, I have to make a plug. If you have any further questions or would like to make an appointment, you can call 417-881-3880, or, follow the link below. Thank you and Happy Thanksgiving!
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