RICHMOND, Va. (WRIC) — A contract dispute between Anthem Blue Cross Blue Shield and Bon Secours recently escalated with the insurance company filing a cease and desist. They said the healthcare system has been wrongfully denying patients coverage.
After 11,000 Anthem Medicare Advantage patients lost coverage with Bon Secours facilities due to contract re-negotiation disagreements back on Aug. 1. The insurance company’s president, Monica Schmude, said there’s been some confusion.
“If you are a Medicaid member or you’re a commercial member through your employer, you absolutely have access to care,” Schmude said.
Even though Anthem Medicare Advantage patients may have lost coverage, Bon Secours is still considered in-network for Anthem’s patients on Medicaid and other select plans. Patients should check with their providers to see if their specific insurance plan is affected.
“We received some of those members calling us, they’re telling us that Bon Secours facilities are telling them they can’t get care at their facility, or their care is being disrupted because there are no longer in-network,” Schmude said.
A Bon Secours’ representative said these claims are “unfounded and false.” Chief Clinical Officer of Bon Secours of Richmond, Peter Charvat, added that even though the two parties couldn’t successfully re-negotiate their Medicare contracts, they hope to come to an agreement for Medicaid customers. However, the clock is ticking. They said this re-negotiation must come before October.
“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 explained.
Schmude also hopes the two groups can reach a fair decision.
“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.
In the meantime, Bon Secours encouraged affected patients to consider seeking open enrollment opportunities and to “explore their options.”
If a patient is a Managed Medicaid member and at risk to lose their provider through a network change potentially beginning in October, they should call Cardinal Care, Virginia’s Medicaid Program, at 1-800-643-2273 to initiate a Change for Cause transfer to an alternative Managed Medicaid plan to ensure you can retain long-term access to your provider. Bon Secours remains in-network with all other major Managed Medicaid plans in Virginia.Bon Secours
Anthem reminded customers that there are special circumstances that allow impacted patients to continue to see their Bon Secours providers at no additional charge regardless of contract negotiations. The insurance company provided the following information for patients:
We are helping our Medicare Advantage members transition elective care to one of the many other available health systems, physicians, and facilities in our network. We are also working to assist members who require continued care with their current provider for certain serious and complex conditions. Please see www.Anthem.com/BonSecoursVirginia for the latest information on Bon Secours’ decision to leave Anthem’s network.Anthem Blue Cross Blue Shield