Local Health Care System Out of Network

[somarco]

Mercy Health may become out of network for Ohio Medicare Advantage patients.

It would go effect Oct. 1 and impact 17,000 people in the Greater Cincinnati area.

Contract negotiations between Mercy Health and Anthem are stalled.

Mercy Health became out of network for Anthem.


https://local12.com/news/local/merc...iations-hospital-healthcare-system-cincinnati

 

[goillini52]

Mercy Health may become out of network for Ohio Medicare Advantage patients.

It would go effect Oct. 1 and impact 17,000 people in the Greater Cincinnati area.

Contract negotiations between Mercy Health and Anthem are stalled.

Mercy Health became out of network for Anthem.


https://local12.com/news/local/merc...iations-hospital-healthcare-system-cincinnati

More scare tactics?

 

[axeman462]

More scare tactics?

he doesn't know anything else.
I could sit here all day googling reason that OM are bad, and posting them on a forum as well, but I have clients to serve and policies to sell.

 

[goillini52]

he doesn't know anything else.
I could sit here all day googling reason that OM are bad, and posting them on a forum as well

I wish you would, I'd like to see them.

 

[somarco]

More scare tactics?

AM news feed . . .

Hospital / carrier negotiations break down about every 3 years or so. Sometimes the dispute is settled at the 11th hour, sometimes they are at an impasse for weeks or months. And sometimes it is permanent . . .

Eventually these things USUALLY work out but not without creating tension for clients and prospective clients.

Locally, Northside and Anthem negotiations reached a stalemate in December, 2021 which meant the contract would expire in January, 2022. A lengthy court battle that provided temporary injunctive relief ensued until a final settlement in July, 2022.

During that time Anthem policyholders (exclusive of Medigap) could still use Northside providers, at least in theory. Some Northside providers were refusing to accept any insurance cards with the Anthem logo. All this, IN SPITE OF memo's issued by Northside explaining that Northside and subsidiaries could still accept Anthem policyholders.

I had Anthem Medigap policyholders calling, asking me to switch them to another carrier even though many of them would not qualify medically. In one situation I had to ask Anthem to contact the provider direct telling them to explain that Medigap policyholders were not included, or affected, by the contract in limbo.

So MOST of the time these things are resolved but not always. There are at least 2 hospitals I know of who have a "permanent" embargo against certain carriers, so it does happen.

Point is, if you have a client that is receiving ongoing treatment at an embargoed hospital, that scenario creates additional stress on them. I have had this happen before more than once and it is not pleasurable to get a call from a client who is being treated for cancer and needs to have access to the hospital or clinic for infusion therapy.

I really don't care if agents want to say this never happens because it just shows their ignorance and insensitivity to client needs.

 

[goillini52]

AM news feed . . .

Hospital / carrier negotiations break down about every 3 years or so. Sometimes the dispute is settled at the 11th hour, sometimes they are at an impasse for weeks or months. And sometimes it is permanent . . .

Eventually these things USUALLY work out but not without creating tension for clients and prospective clients.

Locally, Northside and Anthem negotiations reached a stalemate in December, 2021 which meant the contract would expire in January, 2022. A lengthy court battle that provided temporary injunctive relief ensued until a final settlement in July, 2022.

During that time Anthem policyholders (exclusive of Medigap) could still use Northside providers, at least in theory. Some Northside providers were refusing to accept any insurance cards with the Anthem logo. All this, IN SPITE OF memo's issued by Northside explaining that Northside and subsidiaries could still accept Anthem policyholders.

I had Anthem Medigap policyholders calling, asking me to switch them to another carrier even though many of them would not qualify medically. In one situation I had to ask Anthem to contact the provider direct telling them to explain that Medigap policyholders were not included, or affected, by the contract in limbo.

So MOST of the time these things are resolved but not always. There are at least 2 hospitals I know of who have a "permanent" embargo against certain carriers, so it does happen.

Point is, if you have a client that is receiving ongoing treatment at an embargoed hospital, that scenario creates additional stress on them. I have had this happen before more than once and it is not pleasurable to get a call from a client who is being treated for cancer and needs to have access to the hospital or clinic for infusion therapy.

I really don't care if agents want to say this never happens because it just shows their ignorance and insensitivity to client needs.

Yep. The largest Hospital/Medical Group in my area has been OON the last couple of years. They only accept the MA that they own (Health Alliance). I had people calling telling me they won't accept Aetna, BCBS and I assured them that didn't include their Med Supps. Another group has a sign at the reception window saying they won't take Humana or UHC.
But these are just scare tactics.

 

[somarco]

But these are just scare tactics.

Are they effective?