ST. LOUIS — Mercy says its services will no longer be in network through Anthem Blue Cross Blue Shield insurance plans in Missouri starting next year unless the two sides can reach a new agreement.
In a news release Sept. 9, Mercy said it provided written notice to end its contracts with Anthem after months of unsuccessful negotiations. The change will move Mercy providers out of network for all Anthem plans, including all commercial, Medicare Advantage, Affordable Care Act marketplace, managed Medicaid plans and HealthLink.
The change will not affect Mercy's retail pharmacy's services.
The change will go into effect on Jan. 1, 2025.
“The cost of providing actual care for patients has risen significantly due to inflation, but Anthem has not kept pace with those rising costs when it comes to reimbursing us for the care we provide to our communities,” Dave Thompson, Mercy’s senior vice president of population health and president of contracted revenue, said in the press release.
An Anthem spokeswoman said Mercy is trying to force them to agree to "drastic price demands" and "charge our members and employers by five times the current inflation rate."
Reaction is now growing on social media.
"Now I get to find all new doctors," one person wrote.
"I love Mercy. That's who I know. SMH," another posted.
"If this doesn't get resolved by 1/1, you can always go to a virtual doctor or a convenience care clinic. I'm a little more worried about...people with specialty doctors or treatments because it does take longer to get into a new doctor," said Kelly Rector with the O'Fallon, Missouri, insurance broker, Denny & Associates. "People can't just change insurance companies in the middle of the year...We don't want to knock any one carrier or any one network out of that equation if we don't have to."
She said negotiations with providers and insurance companies happen routinely. We just don't hear about it until it gets this late in the game, when providers have to notify you if there could be changes.
"I believe both companies actually need each other...I believe they will come together and find a solution soon because failure is not an option. The community is relying on them to do the right thing," Rector said.
Mercy is the second largest physician group in the St. Louis area with more than 1,000 local physicians, according to analysis by the St. Louis Business Journal.
Thompson said there are "hundreds of thousands of Mercy patients with Anthem BCBS."
Anthem's full statement is as follows:
"Mercy has informed us that if we do not agree to their drastic price demands, they will leave our health plans starting January 1, 2025. 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."