Anthem Blue Cross and Blue Shield in Ohio’s Negotiations with OSU Wexner Center and The James Cancer Center
November 06, 2024OSU has notified Anthem Blue Cross and Blue Shield in Ohio that it will no longer accept Anthem Medicare Advantage members starting January 1, 2025.
They have also threatened to leave our employer-sponsored health plans network on January 1, 2025, unless we agree to allow them to drastically increase the prices that they charge to patients covered by Anthem.
What’s Happening?
Our current contract with OSU Health System – including its doctors, Wexner Medical Center, and The James Cancer Center – is set to end on January 1, 2025. This contract sets the prices OSU charges its patients covered by Anthem.
For members covered by Anthem Medicare Advantage health plans
OSU has chosen to end its contract to serve Anthem Medicare Advantage health plan members on January 1, 2025. This means Anthem Medicare Advantage members will pay considerably more for care at OSU after that date. Please see below for information about alternative care providers in Central Ohio and additional steps we’ve taken to assist members currently receiving treatment at OSU.
OSU has chosen to end its contract to serve Anthem Medicare Advantage health plan members on January 1, 2025. This means Anthem Medicare Advantage members will pay considerably more for care at OSU after that date. Please see below for information about alternative care providers in Central Ohio and additional steps we’ve taken to assist members currently receiving treatment at OSU.
For members covered by Anthem employer-sponsored health plans
Anthem and OSU are working to reach a new multi-year contract to keep them in our employer-sponsored health plans network after January 1, 2025, but OSU currently seeks price increases that would drastically increase healthcare costs for Central Ohio consumers.
Anthem and OSU are working to reach a new multi-year contract to keep them in our employer-sponsored health plans network after January 1, 2025, but OSU currently seeks price increases that would drastically increase healthcare costs for Central Ohio consumers.
These higher costs would hit employers hard as well. 85% of Anthem members in Ohio are covered by employers who directly pay their employees’ healthcare bills. That means that Central Ohio employers would feel the full burden of these price increases – hampering their ability to raise pay, offer benefits, and hire new workers.
Our Offer: Fair Payment Increases That Keep Care Affordable
Anthem has offered reasonable payment increases that are above inflation but keep healthcare affordable for our members. These increases are in line with other health systems and National Cancer Institute Centers of Excellence. Importantly, our offered increases would maintain the James Center’s status as a highly paid cancer center. We have also provided OSU with opportunities to earn millions of additional dollars in increased revenue through quality-based care incentives.
So far, OSU has refused these offers.
Negotiations Continue
We continue to work hard with OSU to negotiate reasonable payment increases that fairly compensate OSU for the care they provide while also keeping care accessible and affordable for all Ohioans.
We remain committed to working collaboratively with OSU to reach an agreement before January 1, 2025.
Frequently Asked Questions
Ohio State has indicated that Anthem notified its hospitals and doctors that they will no longer be in its Medicare Advantage network. Is this true?
This is false. Ohio State officially notified Anthem in June of this year that it will end its contract to serve our Medicare Advantage members on January 1, 2025. Despite our efforts to keep OSU in our Medicare Advantage network at reasonable payment rates, OSU has chosen to stop serving Anthem Medicare Advantage members.
Are you still working to keep OSU in network for Anthem members in employer-sponsored health plans?
Yes. We are working closely with OSU to reach an agreement to keep them in our employer-sponsored health plan networks well beyond January 1, 2025, and we remain optimistic an agreement can be reached. However, we must work together to keep access to care at OSU affordable for their patients covered by Anthem.
How many people could be impacted if OSU leaves both networks?
If OSU leaves both our Medicare Advantage and employer-sponsored networks on January 1, 2025, about 47,000 members covered through Anthem employer-based and Medicare Advantage plans would be impacted.
Please note: Anthem Medicare Supplement members are not impacted, and OSU does not currently participate in Anthem’s individual or Medicaid health plan networks.
What do I need to do right now?
We have begun contacting Anthem Medicare Advantage members who are currently in treatment for serious and complex conditions to arrange for them to continue care with their OSU provider beyond January 1, 2025. Members may also contact our customer service center for assistance with current treatment options or for help finding care at one of our many alternative in-network health systems, including OhioHealth, Mt. Carmel Health System, Central Ohio Primary Care, Cleveland Clinic, and many others.
Anthem members covered by employer-sponsored health plans should continue to seek medical care at the Wexner Medical Center and The James Cancer Center as usual. OSU remains in our commercial network until at least January 1, 2025, and we remain optimistic an agreement will be reached to keep them in our network well beyond that date. Please continue to check this website for updates.
What if I’m being treated at OSU and they leave Anthem’s network?
We know this is especially concerning for our members currently receiving care at OSU. That’s why we’re taking steps to help in the event OSU leaves our network. If you are receiving treatment for a serious or complex condition that will continue past December 31, 2024, please contact our Member Service Center at the number on your Anthem ID card. You may be able to continue your care at OSU for a limited time after that date if you are receiving certain types of care.
What should I do if I need emergency medical care from OSU?
Regardless of network status, 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.
Where can I go for information and updates?
We will update this website frequently in the coming weeks as negotiations continue. Anthem members may also login to the Sydney Health app or anthem.com, or call our Member Service Center at the number on their ID card for more information.
