News: Bon Secours Mercy Health sues Anthem Blue Cross Blue Shields over missing payments

In Virginia, an ongoing contract dispute between Bon Secours Mercy Health and Anthem Blue Cross Blue Shield (BCBS) has left 11,000 Medicare patients out of network for the health system, according NBC12 news. If the contract isn’t resolved by October 1, close to 40,000 individuals will also find themselves out of network and with serious obstacles to receiving quality care.

Both Anthem and Bon Secours have accused each other of malfeasance.

According to Virginia Mercury news, Anthem BCBS has accused Bon Secours of “using Medicare and Medicaid patients as leverage in an effort to force the insurer to increase its reimbursement rates for services provided to Anthem customers with employer-sponsored or Affordable Care Act plans.”

In January 2022, Bon Secours and Anthem BCBS entered a new three-year contract negotiation; however, according to Anthem, Bon Secours asked for double-digit rate increases.

Bon Secours Mercy Health, on the other hand, has not only claimed that the reimbursement rates Anthem pays its doctors, nurses, and other providers are “not sustainable nor market competitive,” but, also, that Anthem BCBC owes “more than $93 million in outstanding unpaid and underpaid claims in Virginia alone.”

Anthem has denied the accusation, characterizing it as “inflated.”

The dispute is one of many occurring in recent years following the COVID-19 pandemic, as hospitals struggle to keep up with increasing labor, drug, and supply costs. According to the American Hospital Association, hospital expenses rose approximately 17.5% between 2019 and 2022.

Editor’s note: To read the NBC12 news coverage, click here. To read the Virginia Mercury news coverage, click here. To read the Fierce Healthcare news coverage, click here.