Friday, April 27th, 2012
By Amy Kronenberger
JTDM Hospital, Anthem insurance break off ties
Subscribers forced to pay more out of pocket or go elsewhere in network
A long-time major insurance provider has reached a stalemate with a local hospital, forcing hundreds of employees in the area to pay higher costs or look to another hospital for medical services.
After more than 30 years of working together, Joint Township District Memorial Hospital in St. Marys and Anthem Blue Cross and Blue Shield have severed ties.
As of April 13, the hospital is no longer in the network of the companies offering Anthem plans, which include Goodyear-Veyance and AAP in St. Marys and Minster Machine in Minster.
Jeff Vossler, vice president of financial services at JTDMH, said the hospital began negotiations with the insurance company in September. JTDMH asked Anthem to revisit physician referral schedules, revisit compensation for other services and work to treat all payers equally.
"They made no counter offer; they just walked away," Vossler said. "They notified us in October they would not negotiate, so we submitted our 180-day notice."
Benefits managers for Minster Machine and Veyance said the companies have no plans to change providers. About 400 employees are covered by the plan at Minster Machine; Veyance has 340 active members under the plan and hundreds of retirees.
An AAP spokesperson was unavailable for comment.
"All I'm doing is telling people they can still go to Joint Township, but it'll cost them more because it's out of network," Bruce Sparrow, the Veyance benefits representative from United Steelworkers Local 200, said.
Anthem spokesperson Deb Weithop said JTDMH in 2010 signed an agreement effective through Dec. 31, 2012. Anthem agreed to pay a certain percentage of the costs.
"But they cancelled," Weithop said. "They were asking for rates significantly higher than what we originally agreed to, and we stand by those rates."
Weithop said the cancelled agreement includes more than just the hospital. Grand Lake Home Medical Equipment, Joint Township Home Health and Joint Township District Transitional Care also are now out of network.
"We've already let members know that this was happening and encouraged them to find an in-network hospital," she said.
Vossler said the hospital still wants to negotiate.
"We were scheduled to meet Jan. 1 to negotiate, but they didn't show up," he said. "We are still trying to work with them, but they are not returning our phone calls."
Regardless of insurance and ability to pay, Vossler said the hospital emergency room is always open. Also, hospital officials are working on some ideas to lessen the impact to Anthem users.
"I can't say what those ideas are, but we want to help Anthem patients so they aren't put in the middle of all of this," he said.
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Mostly sunny, mild