Lisa Bernard Kuhn reports:
More than 500,000 Cincinnati-area Anthem Blue Cross & Blue Shield members may have to find a new hospital or doctor in April, if UC Health and the health insurer can’t come to terms on a new contract.
The two groups are at odds over reimbursement rates, the amount Anthem pays to hospitals and doctors for the care provided to its members. The firms are up against an April 15 deadline to finalize an agreement, or Anthem’s members will be forced to pay out-of-network rates should they chose to stay with UC Health.
Anthem – the largest health insurer in Greater Cincinnati, Northern Kentucky and Southeast Indiana – said Tuesday that its members were sent letters informing them of the pending change. UC Health officials could not be reached for comment.
Anthem spokeswoman Kim Ashley said that UC Health chose to terminate its contract with Anthem unless reimbursement rates were increased.
UC Health is among the region’s largest health systems with 2011 revenues of $1.2 billion and more than 8,600 employees.
“UC Health is already the most highly reimbursed hospital system in Greater Cincinnati, and UC Health is demanding their physicians be paid more than other local physicians,” Ashley said in a statement to The Enquirer. “We negotiate hospital and physician contracts on behalf of our customers because it directly impacts what they pay for their medical care. As much as we want to provide the broadest possible access to health care, it must be at a rate our customers and members can afford.”
She added that “giving in to UC Health’s demands is not in the best interest of our members or the community.”
Ashley declined to share details of the terms of the contracts, but said negotiations are still under way.
Showdowns between insurers and health care providers are not uncommon, particularly as both sides feel pressure to cuts costs.
In 2010, Anthem and UC were part of a similar face off. At the time, UC Health was a part of The Health Alliance, which included Jewish and Fort Hamilton hospitals, West Chester Hospital and Drake Center among others. The Alliance blamed Anthem for trying to cut reimbursements by 3 percent. Ultimately, a deal was struck two days after the original contract expired.