CommonSpirit Health and Anthem Blue Cross Blue Shield Colorado failed to reach a contract agreement by 11:59 p.m. Tuesday, meaning 11 hospitals and dozens of other health care facilities across the state, including Durango’s Mercy Hospital, are out of network for tens of thousands of patients.
Negotiations are ongoing, the organizations say, but it remains unclear when a deal might be reached.
For months, the hospital system and the insurer have tried to negotiate a contract that would set the rates at which hospitals and providers are compensated for care covered by a patient’s insurance plan.
Without a contract, CommonSpirit facilities are not in the Anthem network, meaning patients must seek preapproval for continued coverage, which may be approved at Anthem’s discretion in accordance with network adequacy regulations. However, the step adds a significant burden to patients who would like to keep seeing a CommonSpirit physician, rather than seek care elsewhere.
Anthem spokeswoman Emily Snooks said in an email to The Durango Herald that the organization informed members with “serious medical conditions” that in-network care would be covered at CommonSpirit facilities automatically through July 30.
In an interview Wednesday with the Herald, CommonSpirit Regional Chief Medical Officer Dr. Oswaldo Grenardo said the hospital system will continue to bill patients with Anthem care at the in-network rate through May 10, with the hope that the remaining costs can be recouped if and when an agreement is reached.
CommonSpirit offered to temporarily extend the current contract while negotiations continue. Anthem rejected the offer.
“Short term solutions will only cause more confusion for our members,” Snooks wrote Wednesday. “Anthem remains fully committed to reaching a collaborative, multiyear agreement with CommonSpirit (to) give Anthem members the access to affordable health care that they deserve.”
The disagreement, at its core, is about finances.
Anthem has leveled accusations that CommonSpirit is seeking prohibitively expensive reimbursement rates, which the insurer will have to pass on to the customer.
“CommonSpirit wants to unacceptably increase costs for Colorado consumers and employers,” Snooks said. “Health care cost increases of this magnitude would directly impact our members and local employers.”
The hospital system, alternatively, has argued that its ask is fair, reasonable and necessary.
“If we can't get them to move to a point where we are covering the services that we need to cover currently with the reimbursement rate that they're giving us, that is incredibly problematic from a physician standpoint, and obviously, a patient care standpoint,” Grenardo said.
He argued that CommonSpirit has given up “tens of millions of dollars” in negotiations, while Anthem is “not budging.”
As uncertainty grows, so is the concern among employees with Anthem health plans at major area employers including La Plata County and Fort Lewis College, which has over 1,000 Anthem members connected to its employee health care plan.
Patients seeking more information should reach out to Anthem at 1-877-213-7081.
“If a member needs a specific service that is not available at alternative providers such as Animas Surgical Hospital or Pagosa Springs Medical Center, Anthem will provide a network adequacy exception so that the member can receive care (at) Mercy Hospital,” Snooks said. “Under a network adequacy exception, the member would pay in-network cost-shares.”
The Colorado Division of Insurance is monitoring the situation, spokesman Vince Plymell said. He encouraged patients to proceed with caution and ensure that care is covered at a reasonable rate before they pursue nonemergency treatment.
“As Anthem and CommonSpirit continue to work toward a new agreement, they must be cognizant that increased health care costs are ultimately borne by those same consumers in increased premiums,” Colorado Insurance Commissioner Michael Conway said in a news release.
Liz Mair, a strategic communications specialist who has delivered a flurry of opposition research on CommonSpirit to reporters’ inboxes this week, called the statement an “extremely uncommon” dig at CommonSpirit.
“No, no, no,” Plymell said in response to that spin. “That is basically saying, ‘Hey, both sides need to work together.’”
rschafir@durangoherald.com
