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No end in sight for Anthem-Bon Secours negotiations

It’s been four months since Southampton Memorial Hospital stopped being an in-network provider for Anthem health insurance plans, and there’s still no indication if or when the situation will be resolved.

Bon Secours Mercy Health, which purchased Southampton Memorial Hospital in 2019, confirmed last December that the Catholic health care system and Anthem had been renegotiating to remain in network for Anthem Blue Cross Blue Shield beneficiaries but failed to reach an agreement by Dec. 1, 2020 — the date its previous contract terminated.

The expired contract impacts all Anthem product lines at three Bon Secours hospitals: Southampton, Southern Virginia Regional Medical Center in Emporia and Southside Regional Medical Center in Petersburg. All other Bon Secours hospitals are unaffected and remain in-network providers. Medicare and Medicaid plans are impacted, though some Anthem members may have out-of-network benefits, according to Bon Secours spokeswoman Jenna Green.

“For patients who have Medicare supplemental insurance with Anthem, we encourage them to contact Anthem and verify their benefits using the information on their Medicare supplemental insurance card,” Green said.

As a result, those with Anthem plans who visit an out-of-network hospital could potentially find themselves facing tens of thousands of dollars in medical bills depending on what services are performed and the length of their hospital stays.

“I have health issues that need to be addressed and I am postponing them because of the situation,” said Barbara Nixon of Courtland. “Fortunately, the doctor I see, who is employed by SMH, is in-network. He recently ordered lab work for me and I had to travel to Suffolk to Obici for the blood draw. I have other issues that need to be addressed but I just have not scheduled an appointment with him because I am sure he is going to want me to have a CT or MRI done, which both are very expensive. I do not like traveling all the way to Suffolk, especially with the pandemic.”

Mary Vick, also of Courtland, has an Anthem COVA Care plan through her husband, who works for the Virginia Department of Corrections at Deerfield Correctional in Capron. She’s fearful of what may happen should one of them have a medical emergency and need to be transported by ambulance or airlifted to one of the three impacted hospitals.

“The rescue squads don’t ask where we want to go … I can’t imagine the expense out of my pocket,” Vick said.

Renee Taylor of Franklin has a plan through HealthKeepers Inc., an affiliate of Anthem, through her employer, which “seems to be useless to use it anywhere in Franklin,” she said.

And the three likely aren’t alone in their frustrations. Anthem is one of the largest insurers in the nation.

“Most employers have it; the school system has it,” Vick said.

Green blames Anthem for Southampton’s lapse of in-network status and the delay in reaching a new agreement.

“We do not believe Anthem is working in good faith toward a new contract that puts Southampton Medical Center in network,” she said. “In our opinion, Anthem is falling short of its responsibility to our community by paying hospitals less than competitive rates and expecting patients to shoulder the difference. We believe that Anthem’s actions are not suggestive of either good-faith negotiations or a valued partnership. Anthem is the only major insurer in the market who does not have an agreement with this Bon Secours hospital.”

Anthem’s website, however, claims on its website that the situation arose because Bon Secours “wished to significantly increase costs” at the affected facilities. It claims Anthem “has been engaged in negotiations with BSMH for the last several months in an effort to limit these price increases” but that the company “cannot agree to the price increases BSMH is asking for simply because it would dramatically increase healthcare costs in the Petersburg and Southside Virginia areas.”

“We have had productive discussions with the system in recent weeks,” said Anthem spokesman Jeff Blunt. “Proposals have been exchanged and both parties have been actively working to an agreement. We still are hopeful that an agreement will be reached soon to bring them back into the network.”

Asked how Bon Secours is handling scheduled surgeries so those with Anthem don’t end up with five-figure bills, Green said the hospital proactively identifies patients with Anthem insurance and works with them on an individual basis to determine the best solution.

As for unplanned emergency hospital visits, she emphasized no Bon Secours hospital will turn a patient in need of emergency treatment away, regardless of Anthem’s network status.

“At the same time, we recognize that the cost of health care can be a significant, unexpected expense for our patients,” she acknowledged. “For billing, we work with each patient to address their individual situation.”