Anthem, Memorial Health System seek agreement

MARIETTA - Residents whose health insurance is provided by Anthem Blue Cross and Blue Shield could have to pay out-of-network rates for treatment at Memorial Health System facilities - including both of Marietta's hospitals - if the provider and the health system cannot reach an agreement on reimbursement rates by the end of the year.

The agreement the two companies currently have will be discontinued after Dec. 31 if a new one is not reached, according to Jennifer Offenberger, spokeswoman for the Memorial Health System.

A number of local employers, including Marietta City Schools, have insurance provided by Anthem. Wendy Myers, vice president of the Marietta board of education, said the board has discussed the matter.

"I think we're still hoping they're able to come to an agreement, but obviously as it gets closer, we'll have to look at what our options are," she said.

Offenberger said the health system has been negotiating with Anthem Blue Cross and Blue Shield for three years and the insurance company has not yet agreed to increase its reimbursements to match the rate at which other commercial insurance companies reimburse the health system.

"When you look at the commercial payers that we work with in our system, they (Anthem) fall at the bottom in terms of reimbursement of care and we're asking in these negotiations that they come more in line with what other commercial payers reimburse us for," she said.

Kim Ashley, public relations director for Anthem Blue Cross and Blue Shield in Ohio, wrote in an e-mail the proposal the insurer has made to the health system is "reasonable and fair."

"Throughout the negotiations, Anthem has offered reimbursement rates and terms that are reasonable and competitive, in line with similar contracts throughout the state, and in the best interest of our customers, whose premium dollars pay their health care costs," she said.

Rates were not disclosed by either party, and Ashley said Anthem would not "negotiate confidential contracts through the news media."

She wrote in the e-mail that Anthem is "disappointed" the health system has threatened to end the agreement, and the insurance company wants Memorial Health System to remain in its network.

"Anthem is committed to reaching an agreement with (Memorial Health System), and will continue to advocate on behalf of our customers and the community for affordable health care costs," she said.

Offenberger said the health system is also hopeful that the two can come to an agreement.

"It's extremely critical to us they remain in the repertoire of insurance options for our community," she said. "Negotiations are still in place - we're still trying to talk to Anthem, and we're attempting to resolve this."

Offenberger said the health system has been working with local chambers and brokers so that individuals and businesses will know what their options are if the two companies cannot reach an agreement.

"For example, listening to the brokers, they said you need to bring another insurance product onto the table; so we have," she said.

Offenberger said beginning in August, the Memorial Health System will accept UnitedHealthcare, which serves more than 1.3 million Ohioans.

If the agreement between Memorial Health System and Anthem is terminated and a company continues with Anthem, the company's employees will still be able to utilize Memorial Health System's services, but there will be an out-of-network fee applied, Offenberger said.

Ashley stated in the e-mail that Anthem members in the Mid-Ohio Valley can turn to Camden-Clark Memorial Hospital and St. Joseph's Hospital in Parkersburg, as well as a number of ambulatory surgical centers, radiology facilities and physician specialties in the area if an agreement is not reached with the Memorial Health System.

She urged those with questions or concerns to call the customer service number on the back of their cards, and said the company will keep its members informed.