Some patients with Anthem health insurance received a worrying letter last week informing them that CommonSpirit Health facilities, including Mercy Hospital in Durango, will leave the insurer’s network beginning May 1.
The definitive language in the letter was misleading, an Anthem spokeswoman said, and negotiations remain ongoing to avoid a divorce of the two systems.
“The letter regretfully created confusion and we will work to refine the language in the future so the potential impact is clear,” Emily Snooks said in an email to The Durango Herald.
Anthem Blue Cross and Blue Shield and CommonSpirit butted heads publicly last month over reimbursement rates for care. If the two do not reach an agreement by May 1, nearly all CommonSpirit facilities in Colorado will be considered out of network for patients with Anthem insurance. The rift could subject patients in the Southwest to high costs for care or force them to travel to find in-network providers.
The health insurance provider is the second-largest in the country and is used by many federal employees as well as local employers such as Fort Lewis College.
Derek Ryter of Durango received a letter dated April 1 informing him that he would no longer be able to use Mercy Hospital except for in emergency situations.
“This will hit my family hard,” he said in an email.
When he called Anthem to learn more, he was informed that the letter had led him to a false conclusion.
“I'm also shocked at the verbiage in the letter saying under no uncertain terms that this is going to happen and we had better find new doctors,” Ryter said. “They even outline what we will have to pay and how to submit claims. I guess they are just playing with us.”
A copy of the letter provided by another recipient was reviewed by the Herald. It states that Anthem will cease payment for covered benefits on June 30 and that inpatient hospital stays need to be preapproved starting May 1.
Both organizations have placed the blame on each other. Anthem has argued that the hospital system is requesting unreasonably high reimbursement rates, while CommonSpirit has said that Anthem is asking for rate decreases despite steadily rising costs.
If Anthem and CommonSpirit do not finalize a contract before the April 30 deadline, the insurer “may” extend coverage for patients with ongoing treatment of chronic or long-term conditions.
“It is our hope that Anthem will agree to new, responsible contracts that maintain patient access to essential services as well as the physicians and advance practice providers they know and trust,” CommonSpirit’s webpage on the conflict states.
“Our negotiations are very much ongoing, and we remain hopeful an agreement will be reached that protects our members’ access to affordable care,” Snooks said.
rschafir@durangoherald.com
