Personnel wrote the present reimbursement fees for services it offers to Anthem’s members are “considerably way too very low.”
SCARBOROUGH, Maine — A different Maine healthcare service provider plans to fall Anthem insurance policies because of to the lack of ability to negotiate reimbursement rates that the two corporations can agree on.
Maine’s Coastal Women’s Healthcare (CWH) is the largest independent OB/GYN follow in the point out with about 22,000 overall patients, according to the practice’s president, Dr. Barbara Slager.
Tuesday, CWH despatched a letter to about 8,000 current and former patients in excess of the last 3 decades who use Anthem for their coverage, telling them about the practice’s strategy to halt accepting Anthem starting Aug. 23, 2022.
Staff wrote the present fees of reimbursement for products and services it delivers to Anthem’s users are “considerably also lower to let us to keep on to provide the amount of quality treatment that our people have appear to count on from us.”
In the letter, employees mentioned pregnant patients, or people now in active treatment ideas, will proceed to get care until their treatment strategies are accomplished.
“That implies if you are expecting, regardless of your supply day, we will carry on to see you as a client by way of your shipping and put up-shipping and delivery care,” the letter suggests. “We propose you access out to Anthem straight at the variety on the back again of your insurance policies card to explore any affect on your price-sharing obligations. We sincerely regret any effects this challenging selection has on our people, but we are definitely committed to continuing the system of procedure for our recent people.”
President Dr. Barbara Slager mentioned approximately 38 % of CWH patients have Anthem. She explained Anthem employed that big percentage as leverage to provide minimal reimbursement charges, realizing that if CWH did not renew the agreement, it could probably go out of enterprise.
“They are relying on us staying scared of that,” Dr. Slager stated. “It is really that or go out of small business.”
When asked if dropping Anthem will attain achieving negotiations, Dr. Slager stated, “at this stage we feel like we have no other option but to take a stand on this. We will continue to draw in individuals from unique payers.”
In reaction, Anthem’s spokesperson, Stephanie DuBois, wrote in a statement:
“Coastal Women’s Healthcare provides quality, personalised treatment and we take into consideration them to be an important section of our care service provider community. We believe they ought to be compensated rather for the care they give our members and that has been our goal in negotiations with them. To that finish, we have supplied them generous boosts in excess of the future a number of a long time, which they rejected.
“We have also supplied a one-calendar year extension with a considerable improve in fees to offer time to finalize a longer-term offer, which they also turned down. Rather, Coastal Women’s is insisting on a 70 per cent boost in reimbursement costs, which we simply cannot concur to for the reason that it will drastically impact affordability for our members.
“It is incredibly disappointing they have chosen to walk absent from negotiations by announcing an intention to go away our network, understandably leading to worry among the people. We urge them to re-engage in fantastic faith negotiation attempts with us so our members can continue to acquire the care they count on from Coastal Women’s Health care.”
A spokesperson for Coastal Women’s Healthcare claimed the follow did not ask for a 70 % enhance, and never ever been given an formal offer you for a a person-12 months offer to bridge the potential gap in coverage.
Fore River Urology, a further unbiased apply in Maine, despatched a comparable letter to roughly 10,000 of its individuals notifying them it would drop Anthem for in-network coverage starting off Aug. 1, 2022, also thanks to failed negotiations.