44,000 Reid Health patients affected by insurance changes
RICHMOND, Ind. (Western Wayne News) — Unless there’s a last-minute breakthrough in price negotiations with the Anthem health insurance company, Reid Health and its providers will soon be considered out-of-network for more than 44,000 area patients.
The change would substantially increase out-of-pocket costs for anyone using an Anthem insurance product to cover services from Reid’s hospital, health system, and physician network. That includes employer-sponsored, Medicaid and Medicare Advantage Plans that make use of Anthem.
In a letter mailed out on Saturday to 44,232 affected residents and signed by Craig Kinyon, president, and CEO, and Dr. Rohit Bawa, chair of Reid Health Network Operations Council, recipients were told that “despite our best efforts, we have been unsuccessful in reaching an agreement that best serves the patients Reid Health cares for as the only health care system in the greater Richmond community. Therefore, we have made the difficult choice to terminate Reid Health’s network agreements with Anthem to stand up for our healthcare providers and the patients who depend on them to provide exceptional care.”
Reid told WWN that representatives for the regional health system have been meeting with Anthem on a regular basis for months to find agreement on terms for a new contract. The contract in place now was last negotiated in 1998.
“As the only healthcare system in our area, the region’s safety-net hospital, and one of the nation’s top 250 hospitals, a new, fair agreement with Anthem is mission-critical for Reid Health,” the organization said in a statement.
Insurance contracts like the one between Reid and Anthem govern how much an insurance company pays for all kinds of medical services, procedures, and equipment, and thus significantly influence what a health care provider like Reid and its physicians can charge patients for the same. Contract negotiations typically take into account the size and volume of transactions, the market rates for services in the region, and the financial goals and health of the provider and insurer, among other things.
Jason Troutwine, a vice president at Reid, said that the healthcare landscape has changed significantly in the 25 years since the current contract with Anthem was put in place, especially after the pandemic. He said that a new contract needs to reflect that reality. “In 2023, Reid’s expenses increased more than 8% because of rising labor and supply costs, persistent inflation, clinician shortages, and decreasing reimbursement. During that same time, Anthem’s rate increase to Reid was only 3.7%,” Troutwine said.
An Anthem spokesperson told WWN that “the main sticking point of the negotiations is affordability” and that the rates Reid is requesting go beyond reasonable increases for inflation. “We continue to negotiate in good faith, but unfortunately, Reid is demanding additional cost increases on top of their already high rates. Price hikes of this magnitude would result in dramatic cost increases for Anthem employers and consumers, something that we cannot accept,” the representative said. “At this time, we are recommending our members schedule or re-schedule elective care at one of our in-network care providers. Members may call our service center at the number on their Anthem ID card for assistance and visit anthem.com/reidhealth for more information.”
In June 2023, Reid announced that it was restructuring its services and eliminating about 25 positions in an attempt to close a $48 million gap between its income and expenses. Among the changes was the closure of its employee wellness, sports performance, and massage therapy departments.
Reid says it still hopes to agree with Anthem before the contract expires, but is preparing its staff and patients for the scenario where it cannot. On Friday it held an all-staff meeting to share information about the transition and help ready team members to answer patient questions.
What affected patients can do
This change only applies to those who are current Anthem insurance members. They should know:
- Reid advises keeping previously scheduled appointments for now, but said it will not schedule new medical appointments with affected patients after March 17, 2024, unless an agreement with Anthem is reached.
- Employees on group health insurance plans can consult with their leadership about the possible use of alternative insurance providers that would provide continued access to Reid Health services.
- Emergency room visits for qualified emergency care will continue to be considered in-network regardless of someone’s insurance plan status.
- For patients being treated for a long-term medical condition (such as cancer or behavioral healthcare), or where they have already established a plan of care with their provider (such as for pregnancy), the law requires that Anthem provide “Continuity of Care” coverage for an additional 90 days beyond March 17. Those patients will need to contact Anthem to confirm that their care is covered under this provision.
- Anyone enrolled in an Anthem Medicare Advantage (MA) plan can make a one-time change to a different MA plan or back to Original Medicare before March 31, 2024.
Reid is also encouraging affected patients and employers to contact Anthem’s member services phone line to express support for Anthem continuing to provide in-network coverage of Reid’s services.
Reid has created a dedicated website and helpline for information about the change at ReidHealthAccess.org and 765-965-4250. The website provides details about the negotiation process and Reid’s financial health, as well as resources for affected patients. The phone number will be staffed Monday through Friday from 8:30 a.m. to 4:30 p.m., or callers can leave a message at other times.