Anthem Blue Cross Blue Shield, one of the largest health insurance providers in Virginia, has filed a cease and desist order against Bon Secours, a health care system that operates several hospitals and facilities in the state. The order accuses Bon Secours of wrongfully denying coverage to some Anthem members, amid an ongoing contract disagreement that affects thousands of Medicare Advantage patients.
Anthem claims Bon Secours is disrupting care for Medicaid and commercial members
According to Anthem, Bon Secours has been telling some of its Medicaid and commercial members that they cannot get care at their facilities, or that their care is being disrupted, because they are no longer in network. Anthem said this is false and misleading, as Bon Secours is still considered in-network for Anthem’s 35,000 Medicaid patients and its employer-sponsored plans.
Anthem’s president, Monica Schmude, said that Bon Secours is trying to pressure Anthem into paying higher rates for its Medicare Advantage members, who lost their in-network access to Bon Secours on Aug. 1. Schmude said that Bon Secours asked for a rate increase that was three times the current hospital inflation rate, which Anthem could not agree to.
“What we’re not in agreement with is having one population, in this case, the commercial population or employer-sponsored plans, being asked to pay more and if that population didn’t pay more, that other groups would be terminated from access to bon secours facilities,” Schmude said.
Bon Secours denies Anthem’s allegations and says it is seeking fair reimbursement
Bon Secours, on the other hand, denied Anthem’s allegations and said that it has not denied or disrupted care for any Anthem members. A spokesperson for Bon Secours, Peter Charvat, said that the health care system is seeking fair reimbursement from Anthem to cover the costs of providing high-quality, patient-centered care.
Charvat said that Anthem’s rates have not kept up with the rising costs of labor, supplies, and equipment, which have been exacerbated by the COVID-19 pandemic. He said that Bon Secours approached Anthem halfway through their three-year contract, which was signed in 2022, to renegotiate their rates, but Anthem refused to do so.
“The rates that Anthem is reimbursing our providers [are] not keeping up with the costs, covering the costs necessary to provide high quality, patient-centered care,” Charvat said.
Thousands of Medicare Advantage patients are affected by the contract termination
The contract termination between Anthem and Bon Secours affects about 19,000 Medicare Advantage patients in Virginia, 11,000 of whom are based in Richmond. These patients will have to pay higher out-of-pocket costs if they continue to see their Bon Secours providers or facilities, unless they qualify for continuity of care. Continuity of care is a process that allows patients with special circumstances, such as pregnancy or cancer, to maintain their current rates and providers regardless of network status.
Anthem said it has reached out to its affected members and offered them assistance in finding alternative providers or applying for continuity of care. Bon Secours encouraged its affected patients to explore their options and consider seeking open enrollment opportunities with other insurance plans that cover its services.
The contract dispute could also impact Medicaid patients in October
The contract dispute between Anthem and Bon Secours could also have implications for Medicaid patients in October. If the two parties do not reach an agreement by the end of September, Bon Secours could also become out-of-network for Anthem’s Managed Medicaid plan. This would affect about 35,000 Medicaid patients in Virginia who rely on Bon Secours for their health care needs.
Bon Secours said it remains in-network with all other major Managed Medicaid plans in Virginia and urged its patients to call Cardinal Care, Virginia’s Medicaid Program, at 1-800-643-2273 to initiate a Change for Cause transfer to an alternative plan if they are at risk of losing their provider. Anthem said it hopes to reach a fair and reasonable agreement with Bon Secours for its Medicaid members before the deadline.