Following last week’s announcement that Mary Washington Health and Blue Cross Blue Shield Anthem will go their separate ways unless they can resolve their differences over refund rates, both sides blame the other as customers caught in the middle struggle with anxiety and confusion – especially as they are told different things from both parties.
Anthem warned thousands of people in the Fredericksburg region which Mary Washington Health and all of its hospitals, practices and providers – totaling more than 500 – will be off-grid on 1st of March. However, Anthem will continue to treat MWHC as a preferred supplier until April firsti.e. 90 days from the date of the letter.
Neither party would say how many people are affected. In 2012, when the two had similar differences, Anthem estimated that it had over 77,000 customers in the Fredericksburg region.
The MWHC maintains that it continues to speak weekly with Anthem, the state’s largest commercial insurer, and hopes to resolve the issue. The MWHC decided in September to terminate the existing contract in the interests of fairness, said Eric FlecherSenior Vice President and Director of Health System Strategy.
“The fact is that we are not paid like the others Virginia suppliers. We are paid 24% less than Anthem‘s average payment to other providers,” he said. “So we ask Anthem agree to approximate average payment rates over the life of a new contract. We think that’s more than fair.”
But Anthemspokesperson, Colin Manningsaid the two failed to reach an agreement because “Mary Washington wants to raise prices for our members and businesses by more than three times the rate of inflation in each of the next few years. These types of Drastic increases should not even be considered because of the significant burden they create for families and businesses, which are already hit by high inflation.”
Manning explained that most of their Anthem clients are covered by self-funding schemes, which means that “any increase in the cost of medical services will be paid directly by these clients”.
AnthemMWHC’s disagreement appears almost identical to concerns raised by Cigna Health Insurance in May 2021when the two could not reach an agreement on tariffs.
MWHC insisted it could not absorb the 30% cut offered by Cigna and Cigna said it could not keep MWHC in its network “with the high tariffs and increases they are demanding from our customers and clients,” said holly fussellSenior Communications Advisor for Cigna.
MWHC ended up being out of Cigna’s network for six months until the differences were resolved.
‘Life or Death’
Janet Dodgewho lives in Stafford Countysaid the insurance dispute affects many people: military, federal government and school workers, as well as retirees and residents of assisted living facilities, memory care facilities and nursing homes. medical care.
“My mom is one of them,” she wrote in an email. “Not only would it impact her financially, but it could be life and death if she had to be transported to a hospital other than Mary Washington in an emergency.”
The idea of having to find service providers outside Mary Washington Healthcare ever-changing system is daunting. So does the prospect of retaining the same doctors and paying significantly higher out-of-network fees.
“I’m a nervous wreck because of this health insurance thing,” admitted Joan Turco Rangela Spotsylvania County resident whose husband, Isidro, has required three major surgeries in the past three years. “If we had to pay that difference (to be off the grid), we would be broke. Completely broke.”
Both have Medicare as their primary insurance and Anthem as their secondary. In 2022, they paid $424 one month for coverage. In 2023, the rates are increased to $472 a month – and people often asked Turco-Rangel why she chose such an expensive supplemental plan.
“It was worth all that money to spend in the long run because it covered everything,” she said.
“Some Confusion”
If MWHC and Anthem split, the type of supplemental insurance Turco-Rangel has — the basic option — would no longer pay secondary costs for MWHC services after Medicare pays its share, according to the letter. He also says Anthem customers with FEP Blue Focus would be in the same patch as the Rangels, but those with the Standard option would continue to receive secondary coverage.
Then there’s the issue of the Medicare J supplement, which is no longer offered but is maintained for existing customers like Curtis Dot. She worked for 18 years in from Fredericksburg Commissioner of the tax office and knows a thing or two about tax documents – and insurance regulations.
She did not receive a letter regarding changes to her plan, but called the Anthem number on the back of his insurance card, just to be sure. A Anthem spokesperson told him that the problem only affected those who had Anthem as primary insurance, not those who have it as secondary insurance.
But that’s not what was written in the letter Anthem sent by mail.
When Curtis called Mary Washington Hospitala spokesperson said the contract dispute involves all Anthem clients. Curtis said an MWHC employee who is stationed Facebook updates on this said the same thing.
“The hospital needs to clarify because a lot of people in my situation are really upset about this,” Curtis said.
Then there is the case of King George County resident Bob Baird who recently transferred all of his medical care and that of his wife to Mary Washington Health. He has Medicare as his main insurance and Medicare Supplement F via Anthem.
He was informed by a Anthem spokesperson that secondary coverage would continue, but an MWHC spokesperson said it would not.
“So obviously there is some confusion,” he said.
Covered or not?
The Free Lance-Star asked the MWHC and Anthem to address these discrepancies – and their responses illustrate the level of confusion with complex insurance issues.
Fletcher said Medicare supplemental plans typically don’t have a network. They usually cover coinsurance costs, deductibles, and sometimes things that Medicare doesn’t cover.
“They are intended to reduce out-of-pocket expenses for Medicare beneficiaries,” he said. “Generally … supplemental policies and secondary insurance policies will have out-of-network benefits.”
This explanation contradicts what was said in Anthemletter to customers.
“However, of course, only Anthem can really confirm to its members their coverage,” Fletcher said. “It seems that we are all at Anthemit is mercy.”
The MWHC has answered some of the questions regarding its dispute with Anthem on its website, marywashingtonhealthcare.com/patients-visitors/pay-my-bill/anthem-insurance-plans-qa/.
Those with questions can also call the MWHC at 540/741-1041.
Manning first replied that “Mary Washington’s dismissal would affect all Anthem members – commercial, Medicaid, Medicare – which is why we encourage our members to seek care from other quality providers in the area who are part of the network.”
But what about Anthemin his own letter stating that beneficiaries of Medicare with the standard option would continue to receive secondary coverage?
Manning clarified his statement to say that the termination would affect all Anthem members with commercial insurance, Medicaid and Medicare Advantage.
Anthem addressed the contractual dispute on its website, anthem.com/marywashington/. Customers with questions are encouraged to call the number on the back of their insurance card for information about their specific plans.
Catherine Dyson: 540/[email protected]
