ST. LOUIS — Mercy, one of the St. Louis region’s biggest health care systems, is preparing to cut ties with Anthem Blue Cross Blue Shield, one of the dominant insurance companies in the state, a shift that could leave thousands of area residents having to pay more for medical care.
The two longtime partners have been locked in an increasingly bitter contract dispute for more than half a year, trying to reach a new agreement by the time their current deal ends on Jan. 1.
Parting ways could leave half a million Missourians without in-network insurance coverage at Mercy, said Dave Thompson, Mercy’s senior vice president for population health and president for contracted revenue.
“We do not cross this line lightly,” said Thompson.
“Our preferred scenario would be to keep a network solution with Anthem,” he added. “We feel compelled to raise the bar here.”
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Anthem did not respond to a request for an interview.
Thompson said the lines of communication remain open between the parties. But in recent weeks, Mercy has provided written notice to end the deal, as required within 120 days of termination.
A split could affect how regional employers select what health insurance plan to offer their workers.
Mercy is currently “putting together” ways to help patients and employers navigate any potential changes, Thompson said.
“We feel really strongly in making sure that care is continued,” he said. “The reality is there are a lot of alternatives out there.”
Mercy acknowledged that its disagreement with Anthem is “in part a business dispute” but that there are other sources of friction, too.
For example, Mercy said Anthem requires notification within 48 hours if one of its members receives emergency care, or Anthem won’t pay for it. But Mercy said that because emergency care is unplanned and must be provided before inquiring about insurance, the onus is shifted to patients and health care providers, rather than Anthem.
Other disagreements center on how other types of care — including new approaches like virtual health care — are covered.
Mercy executives said that contract negotiations with Anthem began in March and continue today. But the health system is now trying to navigate two tracks, bracing for different outcomes.
Talks began in March, but Anthem didn’t share its proposal with Mercy until days before the termination paperwork deadline, Mercy said.
Outside experts said that, on one hand, this “shot across the bow from Mercy” could set the stage for significant upheaval, given Anthem’s size and stature in U.S. health insurance.
“You’re dealing with the biggest of the big insurers,” said Tim McBride, a Washington University professor and co-director of its Center for Advancing Health Services, Policy and Economics Research. “That would cause a lot of disruption to the patients.”
He added that similar disputes happen on occasion in health care, between insurance companies and medical providers. And lately, he said he’s seen national data that suggest health care systems are pushing for bigger revenue increases.
But it doesn’t necessarily need to end in the disruptive outcome, McBride said.
“Sometimes these things get resolved before the deadline and everybody just sort of forgets about it,” he said.
View life in St. Louis through the Post-Dispatch photographers' lenses. Edited by Jenna Jones.
