Beginning April 1, University of Missouri Health Care patients with Medicare Advantage plans through Anthem Blue Cross Blue Shield will no longer have access to in-network care.
This could mean higher costs for the approximately 6,800 patients throughout the MU Health Care system impacted by the decision – if they choose to keep their current plans and stay with MU Health.
“We've been in this process for quite some time,” Dr. Laura Morris, the Chief Medical Officer of ambulatory care at MU Healthcare said, “and have kind of gotten to the point where we really need to make sure that we let our patients know.”
While Medicare Advantage plans will no longer be in-network, Morris stressed that negotiations are still ongoing with Anthem regarding other contracts, including employer-based plans and Affordable Care Act marketplace plans.
Morris said MU Health has been asking for an increase in reimbursement rates from Anthem to meet the rising cost of healthcare amid inflation.
She said the proposed rate increase of 39% brings reimbursement rates more in line with similar academic medical institutions in the region, such as those aligned with the University of Kansas, the University of Kentucky and the University of Wisconsin
Morris suggested the reimbursement increase would allow them to reinvest more in the Mid-Missouri community.
“We take some issue with the characterization that this is in any way unusual or excessive, and just want to remind folks that the mission of MU Health Care is to save and improve lives here in Missouri, and we need fair contracts with insurance companies to be able to do that,” Morris said.
In a statement, Anthem said MU Health Care made the decision to leave their Medicare Advantage network beginning April 1.
“MU Health is demanding a price increase of 39% over three years, which is slightly less than their initial proposal. No part of this request is in line with customer expectations or increases accepted by other health systems,” the statement read. “One of Anthem’s primary goals is to protect affordability for those we serve.”
They also said that they will be contacting impacted patients soon to help them find alternative health care providers or establish continuity of care within MU Health for a few specific, complex medical conditions.
Scott Miniea, the executive director of MO SHIP, an unbiased group that assists Missourians enrolling in Medicare, said he was pleased to see that patients were given advance notice that insurance coverage was changing.
He said it’s important for individuals with affected plans to realize they are not without options.
Individuals could change to an Anthem in-network provider, which includes Boone Hospital and Physicians, SSM St. Mary’s Hospital Jefferson City and Physicians, and Jefferson City Medical Group.
A Boone Hospital spokesperson said the organization’s relationship with Anthem isn’t likely to change.
Patients could also change their Medicare Advantage plan during the open enrollment period that is ongoing through March 31.
“You can change from one MA [Medicare Advantage] plan to a different MA plan. You can make that kind of a change, change it during this period,” Miniea said. “But you can also go for a Medicare Advantage to traditional Medicare, and there's some specific considerations if you're doing that.”
He said if people are interested in changing plans or learning more about what Medicare Advantage plans remain in-network at MU Health Care, they can reach out to MO SHIP at (800) 390-3330 or on their website.
But if people want to explore their in-network options with their current Anthem plan, Miniea recommended people contact Anthem directly.
According to an Anthem spokesperson, “members can contact our Member Service Center at the number on their Anthem ID card for more information.”
The deadline for MU Healthcare and Anthem Blue Cross Blue Shield to reach an agreement on their other commercial contracts is March 31, 2025. If an agreement is not reached prior to that date, all Anthem customers could find themselves out-of-network at MU Health Care.
Dr. Morris said she understands this impacts a large number of people throughout the region, as Anthem patients comprise roughly 30% of MU Health Care’s patient population.
“MU Health Care has a pretty broad geographic reach, and there are over 100,000 potential customers of Anthem or patients of MU Health Care out there that could be impacted and no longer have access to in-network services if the negotiations are not resolved,” Dr. Morris said.
She said these negotiations continue in good faith, and patients can, for now, expect business to continue as usual.
