ST. LOUIS 鈥 Mercy, one of the St. 不良研究所导航网址 region鈥檚 biggest health care systems, is preparing to cut ties with Anthem Blue Cross Blue Shield, one of the dominant insurance companies in the state, a shift that could leave thousands of area residents having to pay more for medical care.
The two longtime partners have been locked in an increasingly bitter contract dispute for more than half a year, trying to reach a new agreement by the time their current deal ends on Jan. 1.
Parting ways could leave half a million Missourians without in-network insurance coverage at Mercy, said Dave Thompson, Mercy鈥檚 senior vice president for population health and president for contracted revenue.
鈥淲e do not cross this line lightly,鈥 said Thompson.
鈥淥ur preferred scenario would be to keep a network solution with Anthem,鈥 he added. 鈥淲e feel compelled to raise the bar here.鈥
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Anthem did not respond to a request for an interview.
Thompson said the lines of communication remain open between the parties. But in recent weeks, Mercy has provided written notice to end the deal, as required within 120 days of termination.
A split could affect how regional employers select what health insurance plan to offer their workers.
Mercy is currently 鈥減utting together鈥 ways to help patients and employers navigate any potential changes, Thompson said.
鈥淲e feel really strongly in making sure that care is continued,鈥 he said. 鈥淭he reality is there are a lot of alternatives out there.鈥
Mercy acknowledged that its disagreement with Anthem is 鈥渋n part a business dispute鈥 but that there are other sources of friction, too.
For example, Mercy said Anthem requires notification within 48 hours if one of its members receives emergency care, or Anthem won鈥檛 pay for it. But Mercy said that because emergency care is unplanned and must be provided before inquiring about insurance, the onus is shifted to patients and health care providers, rather than Anthem.
Other disagreements center on how other types of care 鈥 including new approaches like virtual health care 鈥 are covered.
Mercy executives said that contract negotiations with Anthem began in March and continue today. But the health system is now trying to navigate two tracks, bracing for different outcomes.
Talks began in March, but Anthem didn鈥檛 share its proposal with Mercy until days before the termination paperwork deadline, Mercy said.
Outside experts said that, on one hand, this 鈥渟hot across the bow from Mercy鈥 could set the stage for significant upheaval, given Anthem鈥檚 size and stature in U.S. health insurance.
鈥淵ou鈥檙e dealing with the biggest of the big insurers,鈥 said Tim McBride, a Washington University professor and co-director of its Center for Advancing Health Services, Policy and Economics Research. 鈥淭hat would cause a lot of disruption to the patients.鈥
He added that similar disputes happen on occasion in health care, between insurance companies and medical providers. And lately, he said he鈥檚 seen national data that suggest health care systems are pushing for bigger revenue increases.
But it doesn鈥檛 necessarily need to end in the disruptive outcome, McBride said.
鈥淪ometimes these things get resolved before the deadline and everybody just sort of forgets about it,鈥 he said.