Finger pointing, confusion and shifting answers were hallmarks of Wednesday’s exchange between Mercy Health — operator of Paducah’s Lourdes Hospital and several West Kentucky facilities — and Elevance Health (Anthem).
Patients enrolled in these plans should contact the customer service number listed on their insurance card if they have questions.
1. Anthem Blue Cross and Blue Shield
Mercy is pleased to be part of Blue Cross and Blue Shield, which offers a variety of plans and superior customer service. However, each Blue Cross and Blue Shield company operates independently so customer satisfaction may differ depending on where they reside.
Blue Cross and Blue Shield companies in New York tend to boast higher customer service scores, while Pennsylvania insurers tend to have lower scores. When choosing your plan, it’s wise to research local customer satisfaction ratings first.
Bon Secours Mercy Health and Anthem have been locked in an ongoing dispute regarding rates that fail to keep up with inflation and rising labor costs, according to Bon Secours Mercy Health. This dispute began when Anthem (also known as Elevance Health in Ohio) entered Ohio’s managed Medicaid market.
Last week, Mercy hospital system informed its patients that no agreement had been reached and that it would become out-of-network with Anthem Ohio-managed Medicaid as of July 1. But both parties have now come to an understanding which allows Medicaid members to continue care at Mercy physicians and hospitals through standard out-of-network reimbursement during a transition period.
2. UnitedHealthcare
UnitedHealthcare boasts an expansive national network of providers that enables it to cover patients of various kinds with diverse health needs and goals. Their insurance products include Medicare Advantage and Traditional Plans as well as individual/family and employer group health coverage plans.
The company is also an innovator in accountable care relationships, such as its recent agreement with Advocate Health Care of Downers Grove, Illinois to expand the program for 5,500 Medicare Advantage members. Other partnerships include Raleigh’s WakeMed Key Community Care and Palo Alto Medical Foundation in Mountain View, Calif. aimed at improving patient care coordination for Medicare Advantage recipients.
Local 6 reached out to Mercy, which operates Paducah’s Lourdes Hospital and multiple western Kentucky medical facilities, regarding its tenuous relationship with Anthem. Mercy has reported difficulty keeping up with wages and operating costs due to Anthem not keeping pace, leading to more denials and bad debt from claims being denied or not paid on time.
Local 6 reached out to Anthem about Mercy’s claim, but the company declined to make public comments regarding an impending legal matter. Instead, Anthem noted an increase in Medicare Advantage customers as well as substantial investments made towards meeting their needs.
3. Cigna
Cigna insurance paid through their employers must be aware that Cigna and local Mercy physicians have entered into a contract dispute regarding rates of reimbursement for patients. If not resolved by Dec 31st, some ProMedica hospitals and doctors could become “out-of-network” providers to Cigna patients.
Cigna does not participate in the Health Reimbursement Accounts (HRAs) that come with Blue, Silver and Gold plans from Children’s Mercy Health Systems. You can use any funds contributed by Children’s Mercy toward an HRA to pay copayments, deductibles or out-of-pocket medical expenses incurred throughout the year; any unused amounts carry over into subsequent years.
If you work at one of these companies, bring your current insurance card. In most cases, your doctor must obtain prior authorization (an approval request to your insurer for services or procedures) prior to initiating treatments; otherwise you will have to pay at the hospital’s billed rate for those services provided during your appointment.
Health insurance coverage can either be provided through an employer, or it can be purchased privately.
4. Humana
Humana health plans may require you to pay a deductible, which is the amount that must be paid before insurance coverage begins. Your deductible amount depends on which services or prescription drugs you receive; review your plan coverage details to find out about any specific or out-of-pocket costs you may be responsible for paying out-of-pocket.
Humana understands that, depending on the local market, public authorities could cut budgets and decrease demand for private care providers – thereby decreasing framework agreements signed. When this occurs, Humana needs to work tirelessly on gathering knowledge and strengthening relationships through channels such as the Association of Private Care Providers (Vardforetagarna) as well as other Nordic counterparts.
Humana’s efforts at detecting, correcting and preventing fraud, waste and abuse across its operations is integral to its goal of providing affordable healthcare systems for all. Failing to detect such activities could result in legal penalties against Humana as well as damage its reputation – potentially hurting business operations as a whole.
5. Medicare
Medicare is federal health insurance coverage designed for people aged 65 and up or those on disability who qualify. Medicare covers most but not all healthcare costs, although you may choose a Medicare Advantage plan which offers additional benefits and has its own cost structure compared to Original Medicare.
Mercy Health System is one of only five large U.S. healthcare organizations offering a Medicare Advantage plan through Humana Medicare Advantage, giving our patients access to a network of hospitals, clinics and physician offices throughout their region.
Humana and we have entered into a value-based contract that links payments to quality outcomes, giving us more flexibility in providing care when and where it’s necessary, in order to help improve overall health outcomes for its members. This gives us the ability to deliver care tailored specifically for you to optimize overall health outcomes.
Please bring your Medicare insurance card and any paperwork necessary for reimbursement to every appointment. Our patient counselors can help explain your policy to you and submit any needed forms on your behalf for reimbursement, at no charge to you – simply click the link that corresponds with your location to access them.
6. Medicaid
Medicaid is the nation’s primary public payer of healthcare, covering preventive, acute and long-term services. Eligibility requirements are tied to income and asset limits to provide support to those most in need.
Recent years have seen many states implement waivers or demonstration projects to expand Medicaid coverage to populations that would traditionally not qualify, including behavioral health services, home and community based services (HCBS), nutrition or housing programs and others that target social determinants of health like nutrition or housing needs. Unfortunately, even with these efforts many Medicaid enrollees still face difficulty accessing care due to provider acceptance rates or other factors.
Mercy Healthcare System of Toledo and four surrounding cities terminated its contract to accept Anthem’s managed Medicaid patients on Friday at midpoint in a three-year agreement due to perceived low reimbursement rates from Anthem that threatened Mercy’s commitment to community health initiatives. Both sides declined commenting on any details of a new contract that might emerge between them; both also declined comment on details related to it. Applicants seeking coverage through Medicaid must meet certain income eligibility requirements linked with household size and other criteria for coverage – view informational infographics or tables detailing eligibility limits by category by clicking here
7. Medicare Advantage
Medicare Advantage plans (Medicare Part C) provide more cost and care control. Approved by the government, these private health insurance plans combine hospital, medical, prescription drug coverage into HMOs, PPOs or regional PPOs that are typically paid monthly by an individual in addition to their regular Medicare Part B premium payment. Medicare Advantage plans often offer wider networks with fitness programs, hearing aids and vision services not found with traditional Medicare.
People opting for Medicare Advantage plans usually pay higher monthly premiums compared to traditional Medicare. This extra expense may be offset by having either lower or higher deductibles and co-pays for various treatments. It’s essential that before making this decision, speaking with doctors you see regularly as well as considering future needs before selecting an ideal plan that includes prescription drug coverage.
Mercy’s dedication to high-quality healthcare and meeting patients’ needs extends far beyond simply accepting different insurers or financial assistance packages; Mercy also offers comprehensive wellness programs through their MercyMe memberships that provide access to discounted urgent and primary care as well as health education and support services for those who require it.