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 said 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.
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 said 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.”
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.
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.
Anthem said in December that MU Health Care wanted to increase prices.
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.