Anthem Medicare Advantage plans no longer in-network at MU Health Care starting April 1
COLUMBIA, Mo. (KMIZ)
Anthem Blue Cross Blue Shield customers using Medicare Advantage plans will no longer pay in-network rates at University of Missouri Health Care clinics and hospitals starting April 1.
The insurance giant, which has about 2 million members in Missouri, failed to reach a deal to cover those plans in-network after negotiations, MU Health said in a news release Tuesday. Negotiations over other Anthem plans with MU Health continue, according to the release. Those negotiations include Affordable Care Act marketplace plans and HealthLink plans.
MU Health said in December that it was negotiating with Anthem, among the state's biggest health insurance providers.
"MU Health Care and Anthem agreed to focus our negotiations on our commercial contract," MU Health Care spokesman Eric Maze wrote in an email. "Which is a vast majority of our shared patients and includes those who have Anthem through their employer."
About 100,000 patients are insured through Anthem at MU Health Care, according to Maze. And about 7,000 of those patients use the Anthem Medicare Advantage plan.
MU Health Care serves patients in all 114 Missouri counties. It is also the only academic health system in Mid-Missouri, including a Level-1 trauma center and a children's hospital. MU Health Care is one of only two hospitals in the state that provides health care to patients, regardless of their insurance status or ability to pay.
An Anthem spokesperson told ABC 17 News in an email that it is currently discussing a multi-year extension to its existing contract with MU Health Care.
"MU Health is demanding a price increase of 39% over three years, which is slightly less than their initial proposal," an Anthem spokesperson wrote in an email. "No part of this request is in line with customer expectations or increases accepted by other health systems."
Maze said in response that MU Health Care is seeking new rates that cover the increased costs of providing care due to inflation and other market pressures. He said Anthem's processing delays and claim denials have also led to increased administrative burdens.
“More than 30 percent of Anthem’s unpaid claims are more than 90 days old and those claims total more than $20 million owed to us," Maze wrote in an email. "We now have 30 full-time staff assigned to manage the administrative burden of the Anthem relationship.”
He said Anthem also reimburses MU Health at rates well below its peer academic health systems.
An Anthem spokesperson told ABC 17 News in an email that Anthem Medicare Advantage members currently receiving care with MU Health can expect to be contacted soon regarding their options. That communication will address continuity of care at MU Health and access to alternative in-network care providers in Columbia and throughout Missouri.
"We understand the importance of timely access to care for our members, and every effort will be made to assist them with finding alternative high-quality care providers," the Anthem spokesperson wrote.
The email says Anthem aims to protect affordability for those it serves and will continue to work with MU Health to reach an agreement that maintains access to affordable care for our members.
"Patients with Anthem Medicare Advantage will likely pay more out of pocket to see MU Health Care doctors and care teams or may need to find a new, in-network provider for care," Maze said in an email. "While we cannot encourage patients to switch their health plan, we can confirm patients with Medicare Advantage coverage can make a one-time change in plans during the Medicare Advantage Open Enrollment Period January 1 through March 31."
The Missouri State Health Insurance Assistance Program is a federally funded program that provides health insurance counseling for Medicare beneficiaries in Missouri.
“We can just help people understand what all their options are for Medicare, of all the various types that there are in Missouri,” said Executive Director Scott Miniea.
Minea said today’s announcement comes early enough to allow ensured patients time to explore their options.
“Sometimes these kinds of negotiations go right up to the deadline,” Miniea said. “That's why it's nice to have a little bit of a notice on this one.”
He said affected patients have time to figure out what this means for their individual situation and make any necessary changes to their coverage, rather than being immediately subjected to paying out of network fees.
“It [paying out of network fees] would be like not having insurance,” Miniea said. “So ignoring the notice is not a good idea.”
This announcement also comes during the Medicare Advantage Open Enrollment period. It began January 1 and ends March 31.
“It coincides with a nice time to look at your options,” Miniea said. “You have the option to change from one Medicare Advantage plan to another.”
Miniea said Missouri SHIP understands that medicare changes can be scary to people.
“With any of these Medicare related questions, often the best answer is first, call us,” Minea said. “It doesn't cost you anything. We’ll assign you to a counselor who can explain in detail with whatever other Medicare combination of programs and things you have, what this means to you.”
Anyone interested in speaking with a Missouri SHIP counselor about Medicare options can fill out a form on its website.
People can also call the Anthem customer service line on the back of their insurance card to find out what in-network providers are in the area.
MU Health has set up a call center available at 573-650-5409 and open from 8 a.m. to 6 p.m. Monday through Friday to take questions about the change.
Anthem often negotiates with suppliers, according to its list of current contract negotiations. Although most contracts are renegotiated before they expire and the provider stays active in Anthem's network, some circumstances can cause a provider to stop taking part in one or more networks.
Jefferson City Medical Group and Anthem Blue Cross Blue Shield reached a contract agreement in November 2023.
