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Tuesday, November 6th, 2012

Hospital, insurance provider make new deal

By Amy Kronenberger
ST. MARYS - A local hospital and an insurance provider to hundreds of area employees have mended fences.
Joint Township District Memorial Hospital, St. Marys, and Anthem Blue Cross and Blue Shield on Monday announced they have re-established their relationship after severing ties in April. The new agreement, which went into effect Thursday, puts JTDMH, its hospital-based physicians and hospital-employed ancillary physicians back in Anthem's network.
"There were mutual concessions by both parties; both sides gave a little," JTDMH spokesperson Marty Dodrill said Monday.
In April, JTDMH and Anthem were unable to negotiate terms after more than 30 years of working together. The stalemate took JTDMH out of network for subscribers, forcing employees and retirees from Veyance and AAP in St. Marys and Minster Machine in Minster to pay higher costs or look to another hospital for medical services.
Hospital officials had asked Anthem to revisit physician referral schedules, revisit compensation for other services and work to treat all payers equally.
Shortly after the separation, both parties went back to the negotiating table, Dodrill said. Both sides compromised, wanting to reach an agreement that would work for everyone.
In the new two-year contract, Anthem's Traditional/Indemnity, Blue Access/PPO and Blue Preferred/HMO plans will be considered in-network for Anthem members. The new agreement includes JTDMH's participation in Anthem's Quality Incentive Program. The program rewards the hospital for quality performance through additional reimbursement.
"Re-establishing our relationship with Anthem allows all in the region to utilize our facilities," said Kevin Harlin, president of the hospital's parent company, Grand Lake Health System. "We welcome all of Anthem's members to our health system."
Jan Persinger, vice president of provider contracting and engagement for Anthem, said in a press release the company is pleased the two entities are working together.
"This agreement that includes all entities of JTDMH promotes continuous improvements and is a great benefit to the community," she said.
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