I'm so surprised that my hospital announced they may not be reaching a deal with Anthem (BCBS) for 2025. They shared a statement that takes a pretty strong stance about it, too (link below). Anyone else seen this type of thing before?
https://www.mskcc.org/insurance-assistance/insurance-information/msk-anthem-contract-negotiations
Yes, happens when the proposed fee schedule is so low, hospitals and private offices may choose to terminate the contract. It’s also part of renegotiating the fee schedule. It may take a few months to work out a new contract, but this is how it’s done. Sloan-Kettering is an important hospital for Anthem, so a deal could still happen. Same thing happening with UHC. The rates they’re moving to are not sustainable for hospitals and private practice. If providers don’t terminate or threaten to terminate participation, insurers get away with reduced payments. There’s power in numbers, so if enough providers and hospitals terminate, they’ll have to rethink the fee schedules or risk losing providers first, then the insured will drop them for an insurance company who’s network is rich with the best hospitals and providers.
Chief
Ours is doing that with BCBS. Their negotiation date was extended which I was surprised by. I was pretty sure they were just going to part ways. BCBS is terrible for coverage, but so many people have it.
Wow I didn't realize that it had downsides to the plan, but I figured that there was more to the story than what was put out in the statement
Yes happened to us too. We are just communicating with patients that it’s Anthem’s fault (which is true).
As an agent, I see it from both sides. Insurance companies are a business. Recent regulatory changes are putting pressure on this business model to maintain profitability. And that is through the reimbursement rates negotiated in the contract, as well as the denial/delay rates via prior authorizations.
I also see it from the side of my clients (Medicare) - if your PCP has indicated that certain tests and treatment are necessary, who is the insurance company to insert themselves into that conversation? But again, if they don't, it weighs on profitability, and these companies are publicly traded and have shareholders looking for ROI.
I think the foundational premise that bottom line comes into play here is an issue. It's unethical, in my opinion. Not blaming the individual insurance companies or their agents, I just think it's a terrible system to have because it will result in these issues where people are not being properly cared for because of someone's profit margin. 😔