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Mercy, Anthem reach deal to provide in-network benefits

Health care industry giants announce 5-year contract
CommonSpirit Health, which owns Mercy Hospital, and Anthem Blue Cross Blue Shield reached an agreement Friday to provide Anthem members with in-network benefits at all CommonSpirit facilities. (Brandon Mathis/Special to the Herald)
May 1, 2024
‘Hopeless and helpless,’ patients caught between Anthem and CommonSpirit
May 1, 2024
Contract deadline passes with no deal between CommonSpirit, Anthem

CommonSpirit Health, which owns Mercy Hospital, and Anthem Blue Cross Blue Shield of Colorado announced Friday they have reached a five-year agreement to provide Anthem members with in-network benefits at all CommonSpirit facilities.

The announcement ends an impasse between the two health care industry behemoths that extended past a May 1 deadline.

As part of the agreement, any health care services Anthem members received at CommonSpirit since May 1 will be covered at in-network benefit levels, according to a joint news release issued Friday night.

The agreement applies to all CommonSpirit hospitals, outpatient care centers and physician offices across Colorado.

“I’m proud that both organizations stayed at the negotiating table, working hard to reach an agreement to provide Coloradans’ access to affordable health care at CommonSpirit,” said Anthem Colorado President Matt Pickett, in the release. “Importantly, the long-term nature of our agreement ensures care provider network stability for our members and cost-predictability for Colorado employers for years to come.”

Andrew Gaasch, executive vice president and chief financial officer of the CommonSpirit Mountain Region, said the renewed partnership with Anthem will ensure patients continue to receive care from the doctors and nurses they know and trust.

“Our goal has always been to ensure we can meet the needs of our patients while continuing to provide essential services to our communities today and into the future,” Gaasch said.

Ollie Hunter, 11, sits with his mother Christie Hunter in April at their La Plata County home. Ollie has myasthenia gravis, an exceedingly rare autoimmune neuromuscular disease, and needs Mercy Hospitals’ services. The state of his insurance coverage was thrust into question when insurance giant Anthem, his families insurance, and CommonSpirit Health, Mercy’s owner, failed to reach an contract agreement by May 1. The agencies announced Friday evening a deal had been struck to continue providing coverage through April 2029. (Jerry McBride/Durango Herald file)
Some patients relieved, others left feeling angry and used

La Plata County resident Joyce Cohen, who fell skiing in January resulting in a torn ACL and a sprained MCL and LCL, said she is happy Anthem and CmmonSpirit reached an agreement, but she doesn’ know if she will stick with Anthem in the future.

"I'm delighted that they reached a deal,“ she said in an email on Saturday. ”I still don't know if I will choose anthem next time around, but I'm relieved to have coverage through the rest of the year.“

La Plata County resident Christie Hunter said on Saturday she is happy the insurance and health care titans reached an agreement and her family will continue to receive in-network coverage. But she is angry their health care was threatened by negotiations to begin with.

Her son Ollie, 11, has a rare autoimmune neuromuscular disease and a secondary unspecified autoimmune disease. He sees his primary physician at Mercy Hospital about once a week.

“My time would have been much better spent trying to help my son and get him feeling well enough to go to school instead of the amount of hours I've had to spend just to try to get him basic continuation of care,” she said.

On Friday before an agreement was announced, Hunter was still trying to obtain a letter from Anthem confirming to CommonSpirit Ollie’s treatment would be covered by insurance. She said Anthem told her that letter is not typically issued until after a 90-day period.

She was dealing with that despite assurances from Anthem and CommonSpirit billings would be held until an agreement was made and patients should continue to seek treatment as needed.

“Telling patients to go continue with their medical care, without 100% confirming that they will be paying in-network prices, is verging on lying,” she said. “Because it was not being made clear that you might still have to pay out-of-network. It was: ‘Don't delay your surgery. Don't delay your treatment.’”

“It’s just been an enormous amount of time and an enormous emotional drain,” she added.

She said everything that has occurred is just a negotiation tactic by Anthem and CommonSpirit in the pursuit of profits, not patients’ wellbeing, and it’s “predatory.”

As negotiations between CommonSpirit and Anthem continued, Hunter had to postpone testing for Ollie because it was unclear what their out-of-pocket costs would be. She said she also forewent an MRI for herself because despite having a continuation of care, she was going to be billed over $2,400.

Her question then was would Anthem pay that bill or would she be stuck paying out of pocket? She said Ollie’s tests would have racked up thousands of dollars as well.

“While I'm obviously thrilled that they've reached a deal, for our personal situation right now and everybody else here in the Four Corners, I don't believe that anybody nationwide should have to go through what we've just gone through,” she said.

Health insurance is already limited in the United States, being tied to employment and whatever options employers offer, or open market options that are very limited in rural areas, she said. To her knowledge, Anthem is the only insurance available on the open market in the Durango area.

“When these companies start banging heads, basically trying to maximize their profits … we're left without any options,” she said.

She acknowledged CommonSpirit is a nonprofit health system but said it still tries to maximize the money it takes in.

Hunter said she is meeting with nonprofits and legal counsel next week to determine how much interest exists for getting momentum rolling toward change. She wants legislative changes at the national level to prevent negotiations between insurance providers and health systems from impacting patients, who fund their operations to begin with.

“As a rural community in the four corners, we should be very aware of how at risk our situation is when it comes to our health care,” she said.

On Friday, Lindsay Radford, spokeswoman for CommonSpirit, declined an interview request for Saturday, saying CommonSpirit is not commenting any further at this time other than the news release announcing the deal between it and Anthem.

An Anthem spokeswoman did not return phone calls or immediately respond to a request for comment on Saturday.


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