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Southampton Memorial Hospital, Anthem cut ties

FRANKLIN

Effective Dec. 1, Southampton Memorial Hospital is no longer an in-network provider for any Anthem health insurance plans.

According to the website for Bon Secours Mercy Health, which purchased Southampton Memorial Hospital last year, the Catholic health care system and Anthem had been negotiating a new agreement over the past several months to remain in-network for Anthem Blue Cross and Blue Shield beneficiaries, but did not reach a renegotiated contract by Dec. 1 — the day its current contract terminated.

The expired contract impacts all Anthem product lines, to include commercial, Medicare, Medicaid and exchange plans, 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.

“We have worked diligently to reach an agreement with Anthem so we can continue to provide high-quality care for you and protect in-network access to the providers you trust,” Bon Secours’ website states. “However, Anthem did not make any aggregate movement in proposed reimbursement rates over the entirety of this negotiation. As a result, the contracts for these three hospital are now terminated.”

Jenna Green, a spokeswoman for Bon Secours, confirmed renegotiations had been initiated at Bon Secours’ request, on its belief that “Anthem’s current reimbursement to these hospitals is not sustainable or market competitive.” Scott Golden, a spokesman for Anthem, agreed a “fair reimbursement rate” to the three hospitals was “the sticking point” of the negotiations, but claimed the reimbursements Bon Secours had requested “would significantly increase healthcare costs” for patients at the three affected hospitals.

“In these types of negotiations, the provider needs to let us know they are leaving our network,” Golden said, which he claims Bon Secours did via a letter dated Sept. 2.

In doing so, “Bon Secours Mercy Health chose to leave our provider networks in the middle of a public health crisis,” Golden said.

The company has further issued a statement claiming Bon Secours “wished to significantly increase costs” at the affected facilities and that Anthem “has been engaged in negotiations with BSMH for the last several months in an effort to limit these price increases.”

“Anthem and BSMH have a long history of partnership, which is why we continue to work toward a new contract that will bring these BSMH hospitals back into our members’ health plans,” the statement reads. “However, we 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.”

In a frequently asked questions section on its website, Bon Secours denies having expressed a desire to terminate its contract with Anthem during the COVID-19 pandemic, or wanting to raise health care prices at the affected hospitals. Instead, it refers to its letter to Anthem as “a letter of intent to negotiate to Anthem in order to remain in Anthem’s network” and reiterates its claim that the reason negotiations broke down was because Anthem’s current reimbursement to the three hospitals are “not market competitive” and “not sustainable.”

Anthem beneficiaries may have continuity of care benefits included in their plans that allow them to continue their care and receive in-network benefits at the affected hospitals post-termination of Bon Secours’ contract. Anthem is also “working with our members to help them find the care they need at other area in-network facilities,” Golden said.

Bon Secours had suspended patient statements and billing in March for all COVID-19-related testing and treatment, but is still actively billing insurance companies for said costs, including federally implemented coverage for uninsured patients receiving COVID-19 treatment. The patients themselves may still eventually be billed for treatment too, but for now, “patient statements are suspended until we make the necessary arrangements with insurers, lab partners, state and federal governments,” Green said. “Whether patients have a cost share for their COVID-19-related care is based on the payer’s policy.”

Because the contract with Anthem elapsed on Dec. 1, 2020, any services provided before that date should be billed to reflect the in-network status at that time,” Green added. “However, adjudication of claims would be dependent on Anthem.”