After last week’s announcement that Mary Washington Healthcare and Anthem Blue Cross Blue Shield would part ways unless they could resolve their disagreements over reimbursement rates, both sides blamed each other and customers worried. and confusion. We are told different things by two parties.
Anthem informed thousands of people in the Fredericksburg area that Mary Washington Healthcare and all of its hospitals, clinics and providers (more than 500 in total) will be disconnected from the network on March 1st. . 1, this is he 90 days from the date of the letter.
Neither party has disclosed how many people have been affected. In 2012, Anthem estimated that she had more than 77,000 customers in the Fredericksburg area when the two had a similar dispute.
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MWHC continues to have weekly talks with Anthem, the state’s largest commercial insurer, and hopes to resolve this issue. MWHC decided in September to terminate the existing contract, seeking fairness, said Eric Fletcher, the health system’s senior vice president and chief strategy officer.
“In fact, we are not paid as well as other providers in Virginia. “Therefore, we are asking Anthem to agree to approximate the average payout rate over the duration of the new contract, which we believe is more than fair.”
But Anthem spokesman Colin Manning said the two have yet to reach an agreement. Price increases should not be considered, as they would be too costly for families and businesses already affected by high inflation. ”
Manning explained that most of Anthem’s customers are covered by self-funded plans. This means that “increased costs of medical services will be paid directly by those customers.”
Anthem’s disagreements with MWHC sound much like the concerns raised by Cigna Health Insurance in May 2021.
MWHC argued that it could not absorb Cigna’s proposed 30% cut, and Cigna said it could not keep MWHC in its network. for signa.
MWHC will be out of Cigna’s network for six months until the disagreement is resolved.
‘Live or die’
Stafford County resident Janet Dodge said insurance disputes affect a great many people.
“My mother is one of them,” she wrote in an email. there is potential.”
The thought of having to find a healthcare provider outside of Mary Washington Healthcare’s ever-growing system is daunting. So does the prospect of keeping the same doctor and paying significantly higher out-of-network fees.
“I’m nervous about this health insurance,” admitted Joanne Turco Rangel, a Spotsylvania County resident whose husband, Isidro, has had three major surgeries in the past three years. “If we had to pay the difference[because we were off the network]we would have been bankrupt. Completely bankrupt.”
The two have Medicare as primary insurance and Anthem as secondary insurance. In 2022, I paid a monthly premium of $424. With the price rising to $472 per month in 2023, Turco-Rangel was often asked why he chose such an expensive add-on plan.
“It covered everything, so in the long run it was worth the money spent,” she said.
According to the letter, if MWHC and Anthem were split, the Basic Option, the type of additional insurance Turco-Rangel has, wouldn’t pay secondary costs for MWHC services after Medicare paid for that portion. Also, Anthem customers with FEP Blue Focus will receive the same fix as Rangels, while customers with Standard Option will continue to receive secondary coverage. increase.
Then there’s the issue of Medicare Supplement J. This is no longer offered, but is still offered to existing customers like Dot Curtis. She is the Commissioner of the Revenue Service in Fredericksburg where she has been for 18 years and has some knowledge of tax documents and insurance regulations.
She had not received a letter about the change in plans, but just in case, she called the national anthem number on the back of her insurance card. I told her that it only affects those who have it as their first insurance, not those who have it.
However, that’s not what Anthem said in the letter he mailed.
When Curtis called Mary Washington Hospital, a spokeswoman there said the contract dispute affects all Anthem customers. Employees said the same thing.
“A lot of people in my situation are really upset, so the hospital needs to come out with an explanation,” Curtis said.
Then there is the case of King George County resident Bob Baird, who recently switched all his and his wife’s health care to Mary Washington Health Care. I am enrolled in Medicare Supplement F through Anthem.
A spokesperson for Anthem told me secondary coverage would continue, but a spokesperson for MWHC said it would not.
“So obviously there’s confusion,” he said.
covered or not?
The Free Lance–Star has asked MWHC and Anthem to address these discrepancies. Their responses show the level of confusion caused by complex insurance issues.
Fletcher said that Medicare supplement plans generally don’t have networks. These typically cover coinsurance costs, deductibles, and items Medicare doesn’t cover.
“They are intended to reduce out-of-pocket costs for Medicare beneficiaries,” he said. There are advantages.”
That description contradicts what is stated in Anthem’s letter to customers.
“But indeed, only Anthem can truly confirm the reports of its members,” said Fletcher. “We all seem to be at the mercy of Anthem.”
MWHC addresses some questions regarding the dispute with Anthem on its website marywashingtonhealthcare.com/patients-visitors/pay-my-bill/anthem-insurance-plans-qa/.
You can also call MWHC at 540/741-1041 if you have questions.
Manning initially said, “Mary Washington’s dismissal will affect all Anthem members (Commercial, Medicaid, Medicare) and encourage them to seek care at other quality providers in areas within their network.” I recommend it to my members,” he said.
But what about Anthem’s own letter stating that Standard Option Medicare recipients will continue to get secondary coverage?
Manning released a statement saying the termination will affect all Anthem members with commercial insurance, Medicaid and Medicare Advantage.
Anthem handles contract disputes on its website, anthem.com/marywashington/. Customers with questions are encouraged to call the phone number on the back of their insurance card to obtain information about their specific plan.
Cathy Dyson: 540/374-5425