Mercy issues contract warning to Anthem Blue Cross Blue Shield

Mercy has issued a warning to Anthem Blue Cross Blue Shield that may impact health care recipients statewide.

The St. Louis-based health system, which operates locally as Mercy Springfield Communities, intends to end its Missouri contracts with the insurer in 2025, according to a news release. Mercy officials said months of negotiations with Anthem have failed to yield a suitable reimbursement agreement.

"The cost of providing actual care for patients has risen significantly due to inflation, but Anthem has not kept pace with those rising costs when it comes to reimbursing us for the care we provide to our communities,” said Dave Thompson, Mercy’s senior vice president of population health and president of contracted revenue, in the release. “It’s unreasonable for the insurer to increase its premiums to patients and employers and increase its profits while expecting those of us providing health care directly to patients daily to bear the brunt of the higher cost for providing that care.”

Mercy plans to move out of network with Anthem on Jan. 1, 2025, unless a new agreement is reached, officials say. Mercy's contracts in Missouri with the company that would be ended include commercial, Medicare Advantage, the Affordable Care Act marketplace, managed Medicaid plans via Healthy Blue and HealthLink, which is under the Anthem Blue Cross Blue Shield umbrella.

"We will continue to negotiate in good faith with Anthem in hopes of avoiding any disruption to our patients at the end of the year – particularly those patients in need of prolonged, coordinated care," Thompson said in the release. "However, patients and employers considering which health plans to purchase for 2025 should consider whether Mercy, the largest health system in the state, will be in the plan they purchase."

Anthem Blue Cross Blue Shield did not provide a response to Mercy’s contract warning by deadline.

In addition to reimbursement issues, Mercy cited "red tape" that health system officials say makes it difficult for patients to navigate Anthem's system and receive care.

Springfield Business Journal is planning expanded coverage in the Sept. 16 print edition.