Anthem Negotiations with Mercy: What Our Members Need to Know
September 05, 2024October 2024
Mercy has informed Anthem that its doctors and hospitals in Missouri will leave our care provider networks starting January 1, 2025. They have demanded drastic increases in the prices they charge our commercial members and employers for healthcare services.
We continue to work with Mercy to reach an agreement that includes reasonable price increases and maintains access to affordable healthcare at their doctors and hospitals. If a new agreement can’t be reached before January 1, 2025, all Mercy doctors and hospitals will be out of network for Anthem members.
Why This is Happening
Over the next two years, Mercy wants to increase the prices they charge our commercial members and employers by five times the current inflation rate. Mercy has also demanded contract language that would keep specialty medications unnecessarily expensive even when lower cost options are available.
These price increases would mean much higher out-of-pocket costs for our members and skyrocketing healthcare costs for Missouri employers. Eighty percent of our members are covered by employers who pay their employees’ medical bills directly – meaning employers would feel the full burden of Mercy’s extraordinary price increases.
Concerningly, Mercy is also threatening to cut off access to healthcare for our most vulnerable populations – our Medicaid and Medicare Advantage members. In fact, Mercy and Anthem have come to an agreement for our Medicaid and Medicare plans. Mercy, however, is refusing to sign this agreement as a negotiating strategy to get higher prices for employer-sponsored plans.
Anthem wants to keep Mercy in our networks, and we remain committed to reaching a new agreement. As demonstration of our commitment, we have offered Mercy annual payment increases, in excess of inflation, for a multi-year period. We will continue to negotiate in good faith on behalf of our members and employers.
Other Frequently Asked Questions
Will you reach an agreement?
We hope so. Anthem continues to work to reach an agreement before January 1, 2025, and our members may continue to access in-network benefits when receiving care at Mercy until at least that date.
Who will be impacted if Mercy leaves Anthem's plans on January 1, 2025?
If Mercy chooses to leave Anthem’s network, Anthem members enrolled in individual, employer-sponsored, Medicaid, and Medicare Advantage plans will be impacted. Please note that Anthem Medicare Supplement health plan members are not impacted.
If Mercy chooses to leave Anthem’s network, Anthem members enrolled in individual, employer-sponsored, Medicaid, and Medicare Advantage plans will be impacted. Please note that Anthem Medicare Supplement health plan members are not impacted.
Mercy has accused Anthem of making enormous profits but refusing to adequately pay hospitals for members’ care. Is that true?
That statement shows an intentional disregard for the patients and employers who pay for healthcare. Mercy’s patients would see much higher out-of-pocket costs if we were to agree to their price increase demands. Our community’s employers would feel the full impact of these cost increases because most employers pay their employees’ medical bills themselves.
Mercy is using alarmingly misleading numbers in their accusations. As noted in our publicly available 2023 earnings statements, Anthem makes a very reasonable 4.6% profit margin on its health insurance business. According to Sage Transparency Data, Mercy St. Louis makes an 18.6% profit margin overall and a 34% profit margin on patients covered through employer-sponsored health plans. Their other hospitals also enjoy healthy profit margins.
Mercy says their costs are below state average. Is that true?
It’s generally true that Mercy has been a good partner in maintaining affordable access to quality care for Missourians and their employers. For years, they’ve shared our commitment to healthcare quality and affordability. Now, they seem to have abandoned that commitment.
That’s why it’s so troubling that they now want to send prices skyrocketing at more than five times the rate of inflation over the next two years. These increases would make Mercy among the most expensive health systems in the state. Our goal is to work with Mercy to reasonably increase their payments and keep healthcare affordable, not pile excessive healthcare costs on Missouri’s people and employers.
Mercy has said that “red tape” and payment delays are a problem. How do you respond?
An important part of Anthem’s responsibility to our members and employers is to ensure they are being charged correctly for appropriate care. This is true for all health plans. Anthem pays 92% of claims within 15 days, and 98% within 30 days. This is well within industry standards. The real issue in these negotiations is healthcare affordability. Mercy wants to dramatically increase its prices for their patients covered by Anthem and their employers. We are committed to reaching an agreement that maintains access to affordable care.
What if I’m being treated at Mercy and they leave Anthem’s network?
We know this is especially concerning for our members currently receiving care at Mercy. That’s why we’re taking steps to help in the event they leave our network. If you are receiving treatment for a serious or complex condition that will continue past December 31, 2024, you may be able to continue your care at Mercy after that date. Please monitor this website for updates and, if an agreement is not reached as the deadline approaches, please contact our member service center at the number on your ID card for assistance with Continuity of Care accommodations.
Where can I go for care if Mercy leaves Anthem’s network?
We continue to work with Mercy, and we remain optimistic that an agreement can be reached before January 1, 2025, that maintains our members’ access to affordable care at their hospitals and physicians. However, if an agreement cannot be reached, our members can rest assured that our care provider network includes nearly all Missouri hospitals and doctors.
Choosing an in-network care hospital or doctor is always the most affordable option for care. Members may call our service center at the number on their Anthem ID card for assistance with finding an in-network care provider. Members can also find a doctor or care facility on the Sydney Health app or anthem.com.
Even if Mercy leaves our network on January 1, 2025, members should always call 9-1-1 or go to the nearest emergency room in a life-threatening situation. Coverage will be provided according to the member’s policy benefits and in-network cost shares.