Anthem insurance customers in Colorado may have to switch hospitals if fee dispute not resolved

Patty Damon can see the Lakewood campus of St. Anthony from his home, but starting in May, he may no longer be able to go there without digging into his pockets.

Damon has insurance through Anthem BlueCross BlueShield of Colorado, which is in a dispute with the owner of St. Anthony, CommonSpirit Health. If the two can’t reach an agreement by May 1, CommonSpirits’ 10 Colorado hospitals will no longer be in network for the 1.5 million people covered by Anthe’s health plans in that state.

When a health center leaves the network, patients can still choose to receive care there, but the center can bill them for the difference between their charges and what the patient’s insurance is willing to pay, which could be thousands of dollars. dollars , depending on the type of care received. Federal and state laws protect people who get out-of-network care from surprise bills in an emergency, but not when they could choose a different hospital.

Damon is scheduled for orthopedic surgery in San Antonio in June, and she’s not sure if she’ll be able to have the procedure or if she’ll have to find a new doctor and start the process of getting on the surgical calendar everywhere. again. Either way, you will need to find a different provider for your physical therapy after surgery if CommonSpirit goes out of network.

“This doesn’t seem to be about patient care,” Damon said. “This is about money, and the patient is secondary.”

Representatives for both Anthem and CommonSpirit said they are optimistic they can reach a deal by the middle of next week, but did not provide details on their negotiations. Both said the disagreement centers on tariffs.

If the two sides can’t reach an agreement, Colorado patients should reconsider going to get care at CommonSpirit’s 10 hospitals, eight urgent care centers, two surgery centers, seven home health providers and hospices, 26 radiology centers and five groups of doctors. . The hospital St. Fort Morgan’s Elizabeth would remain on the network until mid-July, because it has a separate contract.

While patients in the Denver area have other options within a relatively short distance, patients in Summit County will have to drive to Vail or Leadville if they need non-emergency hospital care. CommonSpirit also owns Durango’s only general hospital.

Patients who are currently pregnant or undergoing treatment for a complex disease, such as cancer, could continue to go to the same location for care. However, they would have to file the refund claim themselves, according to a letter Anthem sent to its customers.

Anthem alleged that CommonSpirit had requested rate increases at more than twice the rate of inflation. CommonSpirit responded that Anthem had asked for significant rate reductions. Because the negotiations are not public, patients have no way of knowing what the truth is, or whether it may be both.

Rate disputes are not uncommon as both insurers and hospital chains get bigger and try to use their muscle to push payments that benefit them. In 2021, UCHealth went out of network on Anthem plans sold in the Denver-area individual market, though the parties reached an agreement to bring them back at least a year later.

Matt Pickett, president of Colorado business plans at Anthem BlueCross BlueShield, said the insurer is still talking to CommonSpirit but is also reaching out to customers with complex conditions to discuss their options if the split happens . If Anthem were to pay the rates CommonSpirit wants, insurance costs would increase significantly for customers and their employers, he said.

“The last thing we want to do is disrupt care for these members,” Pickett said. “Affordability is the key issue.”

Anthem recently reached an agreement with AdventHealth, the other half of the former Centura Health, Pickett said. HealthOne and UCHealth facilities will also remain in network in Colorado, he said.

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