Bon Secours Health System’s Medicare Advantage contract with Anthem (Elevance Health) in Virginia is due for renewal, yet neither company can reach an agreement regarding reimbursement rates – meaning thousands of Hampton Roads patients with Anthem Medicare Advantage will drop out of network this fall.
Get more insight into what this means for you.
Medicare
Bon Secours has pledged its dedication to keeping Medicare patients covered during Anthem’s contract dispute with Elevance Health and its parent company Elevance. Both parties recently reached a multi-year deal which will keep Bon Secours hospitals, outpatient care centers and physician offices within Anthem’s network through 2028; additionally this extends coverage for Anthem employer-based and ACA plans which had already remained within this coverage during nearly a year of negotiations.
Anthem Medicare Advantage and Medicaid members now benefit from having access to Bon Secours physicians and facilities throughout Ohio, Kentucky and Virginia as a result of this new agreement. Furthermore, this commitment includes settling ongoing claims disputes according to a Friday announcement.
Bon Secours has taken several steps to reduce medical costs for their patients. One such method is its Bon Secours Value Network – an extensive listing of physicians and facilities who deliver high-quality, individually focused care at the most cost-effective level possible. It boasts more than 185 locations throughout Richmond and Hampton Roads including five award-winning hospitals, primary/specialty care practices, continuing care sites and continuing care sites – that make up this network.
Cigna and Bon Secours’ Value Network work in collaboration to enhance patient care further, providing registered nurses as clinical care coordinators that help ensure patients get appropriate follow-up care, preventive screenings and medications on time. The Bon Secours Value Network program is open to employees and retirees who hold Cigna Medicare Advantage plans who wish to participate.
Anthem issued a statement saying Bon Secours used its contract dispute as “a negotiating tactic to force us to accept unsustainable rates for services rendered to Medicare Advantage and ACA members.” Additionally, this week they announced they will terminate an existing contract set to expire in 2025 to provide care for Anthem-managed Medicaid patients; that decision is set to go into effect later this fall.
We have put together a selection of resources to assist in navigating these changes, which you can find here.
Medicaid
Bon Secours Mercy Health has temporarily suspended enrollments of Medicaid patients due to an ongoing contract dispute with Anthem Blue Cross and Blue Shield. Both parties are at odds regarding reimbursement rates which do not keep pace with rising labor costs, according to a statement issued by Bon Secours Mercy Health.
Anthem announced in a separate statement that Bon Secours was using Medicare Advantage and Medicaid patients as bargaining chips in negotiations to secure higher premium rates for people covered by employer-based plans and those purchasing individual policies through the Affordable Care Act marketplace. “Bon Secours has deployed an alarming negotiating tactic by using these vulnerable populations’ health care needs as leverage for double-digit rate increases,” Monica Schmude, president of Anthem Blue Cross and Blue Shield in Virginia stated in her statement.
Anthem Medicare Advantage plans could potentially jeopardize access to Bon Secours doctors and hospitals for thousands of beneficiaries who rely on them, according to an ongoing contract dispute between Bon Secours and Elevance Health owned Anthem – potentially leaving nearly 19,000 Virginia Medicare Advantage plan beneficiaries exposed starting Tuesday as they could likely pay more when seeing Bon Secours providers.
However, by applying for continuity of care before Tuesday these patients could keep their current Bon Secours doctor and may not need to find another one. They’d also be able to keep the same pharmacy.
Individuals enrolled in a Bon Secours Medicare Advantage plan who do not wish to incur out-of-pocket charges when visiting doctors can join the Bon Secours Value Network, which features five award-winning hospitals, primary and specialty care practices, ambulatory and continuing care sites as well as other services and 700 board-certified doctors throughout Richmond and Hampton Roads regions.
This plan also offers a personal health care advocate to navigate the healthcare system and identify any barriers to quality health care, a patient portal with personalized health information and reminders for tests, prescription refills and appointments and integrates with health savings accounts (HSA) for tax benefits on medical expenses.
Commercial Insurance
Commercial insurance is a type of business insurance designed to cover the costs associated with running a company and protect it against any unforeseen events or liabilities that might occur as a result. There are numerous different forms of commercial coverages, such as general liability, professional liability and property insurance. Each form offers specific risk management coverages designed to keep operations running smoothly.
Bon Secours Hospital Cork accepts most major private health insurers and self-paying patients, but patients should always contact their insurer to check what services are covered and which documents may be needed for admission – for instance, some policies require referral or certification to gain admittance to hospital – failing which the claim could be denied and ultimately cost the patient.
On Monday, Hampton Roads Hospital System and Anthem could not reach an extension agreement for their contract, meaning Medicare Advantage patients living in Hampton Roads and Richmond areas were no longer covered by their provider starting August 1. The health system cited Anthem as not offering enough funding to cover staff wages as well as healthcare expenses.
Bon Secours issued a statement declaring its intent to provide affordable access to healthcare to Virginians while working toward reaching an agreement with their insurance provider.
General liability insurance is an essential form of commercial coverage. It covers claims related to bodily injury and property damage as well as personal or advertising injury claims such as libel or slander, which businesses should have as an added layer of financial protection against financial loss.
Professional liability insurance provides businesses with another form of commercial coverage to safeguard them against claims resulting from the provision of services, and may cover legal fees, compensation payments and damages awarded due to malpractice or negligence.
HSA-Eligible Plans
Health Savings Account (HSA) plans are an ideal way for individuals who want to save tax-free money for out-of-pocket medical expenses, and typically paired with high-deductible health plans. With an HSA, you can set aside money each year toward meeting annual deductible costs or reimbursed costs not covered by health plans (See IRS Publication 502).
Bon Secours physicians participating in the Anthem Value Network are available for patients enrolled with an Anthem Medicare Advantage plan in Hampton Roads and Richmond. Depending on your specific coverage, an authorization from Anthem may be necessary before seeing one of our network doctors; this could be for reasons including an agreed upon fee that differs from their billing, or because you need ongoing health issues being treated by one doctor in particular.
Anthem Medicare Advantage plans and insurer are locked in a contract dispute that’s currently forcing Bon Secours health system out of Medicare Advantage and Part D networks. Patients enrolled in an Anthem Medicare Supplement plan, employer sponsored plans or the Affordable Care Act marketplace plans can still see Bon Secours doctors until their contracts expire.
As health systems negotiate, we are providing Anthem patients with information on the differences between in-network charges and out-of-network ones. Utilizing out-of-network providers may lead to significantly higher out-of-pocket costs; according to St Francis Hospital in Richmond’s government-mandated pricing sheet, for example, out-of-network patients could pay up to three times more than an in-network patient when renting a private general room there.
Bon Secours Value Network offers an expansive roster of board-certified physicians who are participating providers for most major commercial insurance plans and many state and local programs. To locate an in-network physician, call your insurance provider or use their search tool online; or search by name using this online tool.
