PORTSMOUTH, Va (WAVY) — A messy dispute between Bon Secours and Anthem is about to get even uglier.
Bon Secours went out of network with Anthem for 11,000 Medicare patients in Virginia earlier this month. Now, the hospital system says it will go out of Network with approximately 35,000 Anthem Medicaid patients on October 1.
“They’re really in a state of panic, and I think that they really just want to know how to stay with us or how to facilitate care elsewhere,” said Dr. Anand Kapur.
Dr. Kapur, Chief Medical Officer with Bon Secours Mercy Medical Group in Hampton Roads, sees patients who are affected, but he is not involved in the negotiations. He told WAVY, “We have a mission that’s dear to my heart, helping the underserved good help to those in need and I think that we do a really good job at it.”
Anthem accuses Bon Secours of using vulnerable patients as pawns to negotiate better reimbursements in the private sector.
Anthem BCBS Virginia President, Monica Schmude said, “I can’t imagine how scary this is for our members, and so we try to stand in their shoes every single day.”
Schmude said Bon Secours is demanding more money from employer-based plans in order to keep the others. She used a family cell phone plan as an analogy saying, “If you don’t pay more, in this situation, the company is threatening to cut off service for maybe your mother, or your daughter, or your spouse.”
The hospital system strongly denies that, telling WAVY via email:
“We are advocating for our ability to continue providing access to high-quality care to some of our most vulnerable communities.”
Bon Secours says its labor costs are up nearly 10% and operating costs up almost 7% from 2021 to 2022. They also contend that Anthem’s reimbursement rates are substantially less than other insurance providers.
The one thing they both agree on is that no one wants to see patients suffer and both say they want to point patients in the right direction so they do not lose care.
Right now those with Medicaid and private employer-based Anthem plans are still in network with Bon Secours.
If you have lost your provider because you have the Anthem Medicare program you can still see your physician either by paying more out of pocket or you may qualify for continuity of care. Call Anthem on the number on the back of your insurance card and they can help you apply or answer any questions you might have.
Bon Secours tells patients: “Open enrollment period begins on October 15 for those with Medicare Advantage plans. If you are worried about losing your physician due to a network change, talk to your broker or call the Centers for Medicare & Medicaid Services (CMS) at 1-800-633-4227 to explore your options. Your broker can help you choose a plan that keeps your providers in-network. Bon Secours remains in-network with all other major Medicare Advantage health plans in Virginia.”
If you are a Managed Medicaid member and at risk to lose your provider through a network change potentially beginning in October, please 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.
