ST. LOUIS — Mercy and Anthem have still not reached an agreement on a new pricing contract.
Laura Rakestraw said she saw firsthand the problems Mercy has had with reimbursements from Anthem after she gave birth to her youngest child in 2018 and she almost got stuck with the bill.
“Our youngest child was born at Mercy Hospital St. Louis in the spring of 2018 and he spent the first two weeks of his life in the NICU there,” Rakestraw said.
It was a difficult time for Rakestraw and her family as her son Aiden needed pretty serious care in the first year of his life.
She has Anthem Blue Cross Blue Shield insurance, they initially paid for the first 30 days of his care, but then Anthem took the money back, leading to a lengthy dispute. Eventually Anthem agreed to pay for most of it.
“But we were still disputing the first few days of our son's life and the total dollar amount was around $70,000 at that point,” Rakestraw said.
This was still going on in September of 2019 when Aiden had to have open heart surgery at Cardinal Glennon and Anthem underpaid.
“So the amount they paid was like $6,000-$7,000 less than what it actually cost Cardinal Glennon to perform his surgery,” Rakestraw said.
Luckily the Rakestraws never got stuck with those bills, but the hospitals did. Because of what she went through she wasn't surprised to hear about the dispute between Mercy and Anthem and wants to see them reach an agreement.
“I think it's also fair for Mercy to say we need to get paid and we should be getting paid a fair rate,” Rakestraw said.
Mercy said the cost of providing care has gone up due to inflation and Anthem has not kept up with it. Mercy doctors say issues with Anthem are affecting their patients in several ways.
“I have patients who come to me and have Anthem insurance and have delays in their care because of denials or because of requirements for prior authorizations. I've witnessed firsthand the anxiety that produces delaying their care or potentially worrying about. Increased financial burden,” Mercy Cardiologist Dr. Jeff Ciaramita said.
A spokesperson from Anthem sent this statement to 5 On Your Side: “Over the next two years, Mercy wants to increase the prices they charge our members and employers by five times the current inflation rate. Mercy has also demanded contract language that would keep specialty medications unnecessarily expensive when lower cost options are available. Anthem has offered reasonable payment increases in excess of the consumer price index for each of the next two years and we continue working hard to reach an agreement. We refuse to put our members or their health care providers in the middle of this negotiation.”
Mercy said they have hundreds of thousands of patients in their care, including their employees, with Anthem insurance and for right now nothing has changed.