No deal on Medicare for Anthem, Bon Secours

Insurance dust-up will push about 6,000 in Hampton Roads out of network

Bon Secours Mercy Health and insurance company Anthem/Blue Cross Blue Shield failed to reach an agreement on reimbursement rates Monday, leaving around 6,000 Hampton Roads residents who use Medicare out of network as of today.

This means that most people who have an Anthem/ BCBS-managed Medicare plan and use Bon Secours Mercy Health medical services will need to find new providers or pay out of pocket. The insurance company’s Medicaid plans are still in-network at Bon Secours until the end of September, when they will lapse if the companies don’t resolve their negotiations.

Anthem/BCBS members who get their health insurance through their employer or the Affordable Care Act marketplace are not affected.

There are some exceptions, such as for continuity of care in pregnancy and other medically delicate conditions, that will allow patients to remain covered with the same providers, according to Anthem spokeswoman Kersha Cartwright.

People who will be impacted received a letter notifying them of their options, she added, and plan members can also call the member services number on their insurance cards or visit www.anthem.com/bonsecoursvirginia.

In an unrelated contract, Anthem’s agreement with Mid-Atlantic Women’s Care, which includes 19 OB-GYN practices in Virginia, was also set to expire at midnight. Negotiations were ongoing as of press time, Cartwright said, and up-to-date information is available at www.anthem.com/ MAWC.

The companies’ contract runs through 2024, but Bon Secours has the option to terminate coverage before it ends. If an agreement isn’t reached

before the end of September, Bon Secours will drop Anthem/BCBS-managed Medicaid plans as well.

“What Anthem BCBS pays our doctors, nurses and other caregivers is not equitable or market competitive,” Bon Secours said in a statement. “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.”

According to a statement from Anthem, Bon Secours’ move to terminate the plans is a bargaining chip in negotiations that started in October with Bon Secours asking Anthem to triple its current reimbursement rates.

“We have repeatedly asked Bon Secours to rescind this contract termination and avoid care disruption for these vulnerable populations,” Anthem’s statement said.

If you (or someone for whom you provide care) are affected by the termination of plans with Bon Secours providers, please contact Katrina Dix.