Mercy BCBS and Anthem Blue Cross Blue Shield Contract Update

Mercy BCBS has a contract with Anthem Blue Cross Blue Shield, which affects patients in multiple states, including California, Colorado, and Nevada.

This contract update is significant because it impacts how patients access care and receive reimbursement for services.

Mercy has opted to end its relationship with Anthem BCBS, citing growing financial concerns for their patients.

This contract termination will affect a wide range of insurance plans, including commercial, Medicare Advantage, and Affordable Care Act (ACA) marketplace plans.

The change is set to take effect on January 1, 2025, unless both parties reach a new agreement before that deadline.

Managed Medicaid plans, such as Health Blue, and HealthLink, which operates under Anthem BCBS, will also be impacted by this contract termination.

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If no new deal is made, Anthem will no longer be considered an in-network provider for Mercy hospitals starting in 2025.

Patients with Anthem health insurance may face higher out-of-pocket costs due to out-of-network rates if they need to receive care at Mercy facilities.

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Mercy's decision is largely driven by financial concerns, particularly in the wake of Elevance Health's significant income rise.

Elevance Health, Anthem's parent company, reported a 24% year-over-year increase in net income in June 2024, amounting to $2.3 billion.

This substantial financial gain has raised concerns among Mercy leaders about the alignment of Elevance Health's financial gains with the financial burdens faced by patients.

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Mercy is focused on ensuring patients can access affordable and high-quality care, and they're concerned about Anthem's pricing practices and contract demands.

Mercy has kept their patient care costs significantly lower than other hospitals in the region, with 27% less costs for inpatients and 16% less for outpatients compared to other facilities in the state.

Patients undergoing long-term or coordinated care may experience disruptions if Mercy and Anthem can't come to a new contract agreement.

Mercy is committed to minimizing these disruptions by negotiating a new contract with Anthem.

Mercy patients insured under Anthem BCBS plans are facing uncertainty due to the potential contract termination.

Not all services provided by Mercy will be affected by this change.

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Anthem has offered a different perspective on the situation, claiming that Mercy is demanding a price increase five times higher than the current inflation rate.

Emily Snooks, Anthem's media contact, emphasized that Anthem had already proposed a reasonable payment increase above the consumer price index for the next two years.

This proposed increase is a key point of contention in the negotiations between Anthem and Mercy.

According to Anthem, Mercy's demands are "drastic" and would result in significant cost increases for Anthem members and employers.

In contrast, Mercy has stated that the cost of providing care has risen significantly due to inflation, but Anthem has not kept pace with those rising costs.

Anthem's proposed payment increase is seen as a way to maintain costs at a "very good rate" for Anthem members.

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Patients with Mercy BCBS coverage will still have access to pharmacy services at Mercy's retail locations, even if Anthem becomes out-of-network for medical services at Mercy hospitals.

This is because Mercy's retail pharmacy locations will continue to serve Anthem patients under their current in-network coverage.

As a result, patients relying on Mercy's pharmacies for prescription medications will receive the necessary services without disruption.

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Mercy's retail pharmacy locations will continue to serve Anthem patients under their current in-network coverage.

This means patients can still get the prescription medications they need without disruption, even if Anthem becomes out-of-network for medical services at Mercy hospitals.

Patients relying on Mercy's pharmacies for prescription medications will still receive the necessary services without interruption, as their in-network coverage will remain in place.

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COVID-19 insurance coverage is a crucial aspect to understand, especially during the pandemic. Diagnostic testing for COVID-19 is covered without cost-sharing under the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relieve, and Economic Security Act (CARES).

Insurance plans are required to cover diagnostic testing without deductibles, copays, or co-insurance. This means you won't have to pay out-of-pocket for diagnostic testing.

However, screening tests for COVID-19, which are used for administrative purposes, are not covered by insurance plans. This includes testing for travel purposes.

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It's also worth noting that antibody testing, which determines whether a patient has a history of COVID-19, is not covered by insurance plans.

To get a COVID-19 test, you'll need to bring some essential documents with you. Here's a list of what you'll need: