MISSOURI – Mercy, one of the largest healthcare providers in Missouri, announced they are ending their contract with the insurance company Anthem Blue Cross Blue Shield at the end of 2024.

The contracts include all commercial, Medicare Advantage, Affordagle Care Act (ACA) marketplace, managed Medicaid plans (Health Blue) and HealthLink (which falls under the Anthem BCBS umbrella). Unless a new agreement can be reached, Anthem will be “out of network” at Mercy hospitals beginning Jan. 1, 2025. 

What You Need To Know

  • Unless a new agreement can be reached, Anthem will be “out of network” at Mercy hospitals beginning Jan. 1, 2025

  • Mercy’s top brass said the decision came out of financial concerns for their patients

  • The Mercy pharmacy locations will continue serving Anthem patients with their current in-network coverage

  • Mercy points to June 2024, when Elevance Health (the corporate name for Anthem) reported an increase of over 24% in its year-over-year net income (valued at $2.3 billion).

In a press release, Mercy’s top brass said the decision came out of concerns for their patients financially. 

“Our focus remains on safeguarding our patients and ensuring they receive the low-cost, high-quality care they deserve with insurance coverage that provides the greatest amount of protection for their health,” said Dave Thompson, Mercy’s senior vice president of population health and president of contracted revenue. “We know this news will be concerning for hundreds of thousands of Mercy patients with Anthem BCBS. We will continue to negotiate in good faith with Anthem in hopes of avoiding any disruption to our patients at the end of the year – particularly those patients in need of prolonged, coordinated care. However, patients and employers considering which health plans to purchase for 2025 should consider whether Mercy, the largest health system in the state, will be in the plan they purchase.”

Mercy points to June 2024, when Elevance Health (the corporate name for Anthem) reported an increase of over 24% in its year-over-year net income (valued at $2.3 billion). They also say Elevance Health also increased over 24% in its year-over-year net profit margin.

Mercy boasts lower average cost for patients compared to other hospitals in state (27% less for commercially insured inpatients, 16% less for outpatients). Over $500 million in free care was made available in the 2023 fiscal year by Mercy. The free care includes traditional charity care, un-reimbursed Medicaid, and other community benefits.

Anthem provided Spectrum News with a statement about Mercy's decision.

"Mercy has informed us that if we do not agree to their drastic price demands, they will leave our health plans starting January 1, 2025," said Emily Snooks, the media contact for Anthem. "Over the next two years, Mercy wants to increase the prices they charge our members and employers by five times the current inflation rate. Mercy has also demanded contract language that would keep specialty medications unnecessarily expensive when lower cost options are available. Anthem has offered reasonable payment increases in excess of the consumer price index for each of the next two years and we continue working hard to reach an agreement." 

While Mercy looks to go out of network for Anthem medically insured patients next year, the notice does not impact Mercy retail pharmacy services. The Mercy pharmacy locations will continue serving Anthem patients with their current in-network coverage.

Mercy said they aim to remove the red tape that’s made it difficult for patients to navigate Anthem’s system causing a “burden and barrier for patients to receive care when it’s medically necessary.” They encourage Anthem patients to voice their concerns with Anthem by calling the number on the back of their health insurance cards or by calling Anthem at 1-800-331-1476. 

Anthem told Spectrum News members can find out the latest information by visiting www.anthem.com/MercyMO