Mercy to end Missouri contracts with Anthem if terms aren’t reached

Mercy’s hospital organization announced Monday, Sept. 9, that it will end its Missouri contracts with Anthem Blue Cross Blue Shield in 2025 if terms are not reached soon.

Mercy stated it provided written notice to Anthem to end its contract. The news was delivered publicly after the hospital organization announced that “months of negotiation” have proven fruitless.

Anthem is a large insurance provider in Missouri, including Cape Girardeau, where Mercy Southeast operates. Anthem spokeswoman Emily Snooks said the insurance provider serves about 9,000 members in Southeast Missouri who accessed a Mercy facility or clinician in the last year.

Mercy will remain in network for medical services with Anthem through the end of the year. The release said the company's notice to end contracts will not include Mercy retail pharmacy services.

Mercy attacked Anthem's "red tape" that makes it difficult for Anthem customers to navigate a system, as well as its rising net income and profit margins.

Anthem claims it has negotiated fair terms and called out Mercy for "drastic price demands."

"Over the next two years, Mercy wants to increase the prices they charge our members and employers by five times the current inflation rate," Snooks said. "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."

Mercy publicly criticized Anthem's patient-facing administrative processes that can "disrupt patient care and, in some cases be life-threatening," Mercy senior vice president of population health and president of contracted revenue Dave Thompson stated in the public release.

The technicalities "are administrative tasks dictated and mandated by Anthem, and they are a barrier to timely, appropriate patient care and can shift the cost of health care away from the insurance provider to those less able to afford it — our patients,” Thompson said. “Our patients have enough to worry about as they are often in the middle of a personal health care crisis. They shouldn’t have to worry about whether their insurance company will approve their coverage. They should be able to solely focus on their health and the health of their family members.”

The hospital system stated that Elevance Health (the corporate name for Anthem) reported a 24.1% increase in its year-over-year net income and a 24.29% increase in its year-over-year net profit margin.

“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,” Thompson said. “It’s unreasonable for the insurer to increase its premiums to patients and employers and increase its profits while expecting those of us providing health care directly to patients daily to bear the brunt of the higher cost for providing that care.”

“We know this news will be concerning for hundreds of thousands of Mercy patients with Anthem BCBS," Thompson stated. "We will continue to negotiate in good faith with Anthem in hopes of avoiding any disruption to our patients at the end of the year — particularly those patients in need of prolonged, coordinated care. However, patients and employers considering which health plans to purchase for 2025 should consider whether Mercy, the largest health system in the state, will be in the plan they purchase.”