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Mercy Health, Anthem accept transition period

WARREN — Bon Secours Mercy Health and Anthem Blue Cross Blue Shield have reached an understanding that allows Medicaid members in Ohio who use Anthem insurance to continue to get care at Mercy Health hospitals and by their doctors.

After months of new contract talks stalled, causing Mercy Health to become out-of-network for Anthem Ohio- managed Medicaid insurance patients — a condition that started Saturday — they’ve agreed to have standard out-of-network reimbursement for a transition period of no fewer than 90 days, according to Anthem spokesman Jeff Blunt.

“This means that continuing care at Mercy Health requires no special out-of-network authorization, beyond typical prior-authorization requirements, to ensure that this vulnerable population will have no disruption in care during Mercy’s exit from the Medicaid provider network,” Blunt said.

According to Mercy Health, the system will serve Anthem-managed Medicaid patients in Ohio through July 31.

“This means that Anthem patients can continue to schedule with their trusted Mercy Health providers through the end of the month,” according to a Mercy Health statement.

Mercy Health recommends during the extended period that Anthem Ohio-managed Medicaid patients contact the Ohio Office of Medicaid to initiate a just- cause transfer to an alternative managed Medicaid plan “to ensure that they can retain long-term access” to Mercy Health providers and facilities.

“Mercy Health is contracted with all managed Medicaid plans in Ohio, with the exception of Anthem, and we will continue to serve our patients under their new health care plans,” according to Mercy Health’s statement.

The health care provider also stated all patients will have access to Mercy Health hospitals for emergency care, regardless of network status with Anthem.

The rate dispute impacts nearly 50,000 Ohioans, including 3,541 people in the Mahoning Valley. On Thursday, a Mercy Health spokeswoman said Anthem pulled back its most recent offer and discontinued negotiations, which have been happening for nine months.

Mercy said it has been experiencing inflationary, labor and supply-cost changes.

Anthem, however, said Mercy Health’s desired rate is more than double the rate of hospital inflation and accused Mercy Health of trying to leverage higher rates from non-Medicaid members by terminating Medicaid members.

Anthem has said it has asked Mercy Health to rescind terminating the contract, honor it and negotiate a new agreement when the contract ends next year.

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