What is going on with the Reid Health and Anthem Blue Cross and Blue Shield contract negotiations?

RICHMOND, Ind. — On March 18, Anthem Blue Cross and Blue Shield customers might lose insurance access from the Reid Health network of medical providers, according to both agencies.

Reid Health and Anthem Blue Cross and Blue Shield have failed to come to an agreement for the past few months.

On Feb. 1, Anthem Blue Cross and Blue Shield released information about the negotiations online at anthem.com/reidhealth, claiming that Reid Health wants to raise health care rates after Anthem provided a 4.7% increase on Jan. 1, which was tied to the consumer-price index to account for the effects of inflation in hospital services.

In Reid Health's statement on its website, reidhealthaccess.org, it states that they "have seen a troubling increase in Anthem delaying or denying care that has been deemed as necessary by Reid Health providers." Reid Health said it has also seen delays in Medicare Advantage plans.

"As dedicated caregivers, we believe that decisions about medical care should be made by a patient and their doctor — not by an insurance company," the health-care provider stated.

In an email to the Palladium-Item, Tony Felts, director of public relations at Anthem Blue Cross and Blue Shield, said, "The main sticking point in these negotiations is affordability. Over the next three years, Reid is proposing to increase health care costs by millions of dollars.

"Reid is asking for multi-year cost increases in their rates, which are already four times the Medicare rate. As the largest payer of medical claims, Medicare serves as a benchmark for reimbursement. More details on Reid’s rates relative to Medicare can be found at rand.com."

Felts said that the rate hikes would increase costs for Anthem-covered employers, where 75% of customers are self-insured, meaning they would pay for employees' claims directly from the company's budget.

Reid Health's states they have "a strong desire to come to an agreement quickly," but that it must be an agreement that helps them take care of the community while it remains an independent hospital.

If an agreement is not reached by March 18, customers of Anthem may not be able to see their physician or provider without paying much higher costs. Reid Health reiterating that anybody can visit the emergency department for emergency care regardless of insurance plan status, the health care provided stated.

Who is at risk?

As of Thursday, Reid Health mailed 44,232 letters to Anthem customers informing them of the negotiations and the risk of losing insurance access, Jason Truitt, a media relations specialist for Reid Health, said in a phone call.

Anthem Blue Cross and Blue Shield added on its website that the contract termination will affect members in individual, employer-sponsored, Medicaid and Medicare Advantage plans.

By law, Anthem is required to provide continuity-of-care coverage to qualifying patients, such as those with a long-term medical condition like cancer or behavioral care, as well as those with continued coverage for those with an established plan of care with their provider such as an expectant mother.

Reid Health advises all Anthem customers to keep any pre-scheduled appointments, even if they are after the March 18 deadline, as they "remain hopeful Anthem will return to the table for good faith discussions."

Any patients who may be impacted by Anthem going out-of-network can call Reid Health's helpline at 765-965-4250. It also advises customers of Anthem call their provider's number on the back of their identification cards to protect their in-network access.

What is Anthem Blue Cross and Blue Shield saying?

Anthem's statement on its website says that it is still optimistic about reaching a new contract deal by the March 18 deadline, but recommends to customers to schedule or re-schedule elective care at other in-network providers:

• IU Health Ball Memorial Hospital, Muncie

• Henry Community Health, New Castle

• St. Vincent Randolph Hospital, Winchester

• McCullough-Hyde Memorial Hospital, Oxford, Ohio

• Wayne Hospital, Greenville, Ohio

A full list of Anthem in-network physician groups in the area can be found on the Sydney Health mobile app or at anthem.com.

Why does this sound familiar?

It's not the first time Anthem Blue Cross and Blue Shield have been at odds over healthcare rates, as the two sides had issues at the negotiating table back in 2019 over the same reasons in Connersville.

At that time in November, Reid Health had no interest in lowering the rates for Connersville, with the two sides eventually coming to an agreement at the end of February.

This article originally appeared on Richmond Palladium-Item: Reid Health, Anthem Blue Cross Blue Shield in contract negotiations