Messy Bon Secours-Anthem dispute threatens to disrupt care for thousands of Virginians on Medicare

St. Mary’s Hospital in Richmond, Virginia, part of the Bon Secours Mercy Health system.
St. Mary’s Hospital in Richmond, Virginia, part of the Bon Secours Mercy Health system.(Sarah Vogelsong (Virginia Mercury))
Published: Aug. 4, 2023 at 10:33 AM EDT
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A messy contract dispute between Bon Secours Mercy Health and Anthem Blue Cross Blue Shield has left 11,000 Virginians who have Medicare plans through Anthem out of network for Bon Secours, which operates numerous hospitals in the Richmond and Hampton Roads regions.

If the disagreement isn’t resolved by Oct. 1, an additional 39,000 Virginians who get Medicaid coverage through Anthem could also find themselves out of network, potentially facing disruption to their ability to get health care. Thousands of low-income people with managed Medicaid plans through Anthem in Ohio already are unable to get their care covered at Bon Secours Mercy Health facilities in that state.

“An entire health system going out of a network doesn’t just impact the hospital,” said Sara Cariano, deputy director of the Center for Healthy Communities with the Virginia Poverty Law Center. “We want folks to be able to access care when they need it, particularly the most vulnerable.”

Anthem has accused Bon Secours Mercy Health of using Medicare and Medicaid patients as leverage in an effort to force the insurer to increase its reimbursement rates for services provided to Anthem customers with employer-sponsored or Affordable Care Act plans.

The insurance giant said the two had entered into a new three-year contract in January 2022 that included annual payment increases for Bon Secours. But it claims that in late 2022, the hospital system asked for double-digit rate increases. Following the failure of negotiations, Bon Secours then exercised a termination provision allowing it to end in-network coverage for patients with managed Medicare plans through Anthem.

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NBC12 is a partner with The Virginia Mercury, an independent, nonprofit online news...
NBC12 is a partner with The Virginia Mercury, an independent, nonprofit online news organization covering state government and policy.(Virginia Mercury)