Continued negotiations between MU Health Care and Anthem Blue Cross Blue Shield resulted in a failure to agree four months after the initial commercial contract ended coverage for approximately 90,000 Missourians.
Representatives from MU Health Care and Anthem met in front of the Missouri Senate Insurance and Banking Committee at the Missouri Capitol on Monday led by committee Chair Sen. Sandy Crawford, R-Buffalo.
During the hearing, Crawford shared stories sent in from Missourians regarding the issue.
One family shared a story about their daughter’s experience at MU Health Care after having received open-heart surgery at both 10 days old and 2 years old.
Now, she is 4, “but the possibility of another surgery still hangs over our family like a shadow,” Crawford read from the family’s account.
Because the family had coverage from Anthem, they are now forced to start over.
“The burden this places on families like mine cannot be overstated. We’re not just talking about switching doctors. We’re talking about losing the very people that kept our daughter alive,” Crawford continued.
MU Health Care CEO Ric Ransom said the hospital system is feeling pressure on its operating margins with operating costs rising approximately 7% year after year.
“What we have said to Anthem is that we need fair market rates to be able to provide the same services,” Ransom said.
He said that if the hospital system can acquire an increase in reimbursement from a contract made with Anthem, the money would mainly go toward maintaining clinical operations, including urgent care facilities, new clinics and pharmacies.
Ransom also noted that MU Health Care wants to see fair pay comparable to other academic institutions with hospitals similar in size, like the University of Kentucky.
However, Ransom said the reason for the hearing is because Anthem hasn’t negotiated with MU Health Care in a year.
Since July 2024, the two entities have gone back and forth negotiating terms that would work best for patients, the hospital system and the insurance company, according to previous Missourian reporting.
As the April 1 deadline loomed, MU Health Care and Anthem began to prep patients for next steps for continuity-of-care options they could receive following end of the contract.
After the contract ended, Anthem members who fell under the following conditions, including pregnancy, cancer treatment, transplant care and recent surgeries, were still able to receive care from MU Health Care professionals at in-network rates through the continuity-of-care plan.
Ransom reiterated how the hospital system tried to engage with Anthem to make an agreement prior to the end of the contracted term but was met with no success.
He said that the plan Anthem responded with was not up to “MU Health Care’s standards or good enough for their patients.”
Rich Novack, the president of commercial markets at Elevance Health, Anthem’s parent company, disagreed with many of the points Ransom made.
Novack said that Anthem did reach out to MU Health Care about creating a continuity-of-care plan, and the hospital system turned it down twice.
Novack also accused MU Health Care of “patient abandonment.”
“This is a technical and legal term where a benefit exists, but the physician or other provider refuses to see a patient that they used to see simply because of a change in coverage,” Novack said.
While Novack said the fact that MU Health Care holds a 2-star rating out of 5 from the Centers for Medicare & Medicaid Services was not a reason for lower rates, he made it clear that Anthem wants to see an increase in quality of care from the hospital system.
However, in regards to coming to an agreement with Anthem, Ransom said, “The reality today is, we are not close. And we have never been close.”
