After nearly three months of Anthem Medicaid patients being out of network with Mercy Health, and a looming threat of Medicare Advantage patients losing coverage through Mercy as well, the two companies have reached an agreement.

This means that all Anthem Blue Cross Blue Shield Medicaid and Medicare Advantage patients will once again be able to receive coverage and care through Mercy Health.

The multi-year agreement with  Anthem will continue to ability for all Medicare and Medicaid patients with Blue Cross blue Shield insurance to continue to use Mercy Health hospitals, outpatient care centers, and physician offices.

According to the press release, Anthem has agreed to cover any claims that patients may have incurred during the period of time that Mercy Health was out of network with Anthem Medicaid since July 1. 

The agreement also extends coverage for Anthem employer-based and Affordable Care Act plans.

Under the new agreement, Anthem members covered by these plans will have access to affordable coverage at Mercy Health until 2028.

“I’m proud that both organizations continued to focus on our shared priority: the communities we serve,” said Anthem Ohio President Jane Peterson. “We worked together to creatively address affordability for our members and the financial needs of an important care provider. This agreement provides long-term stable access to care at Mercy Health without cost increases for our members and employers.”

“We understand that being out network can be very difficult, and we are pleased that patients with Anthem insurance can now see our physicians and use our hospitals at an in-network cost,” said John Luellen, MD, president, Mercy Health – Lorain and Youngstown. “We sincerely believe that access to quality health care services is vital for our communities. This new agreement protects our patients’ access to compassionate care close to home.”

Anthem Medicaid patients have been out of network with Mercy Health since July 1, 2023 when Mercy posted on its website that Anthem patients could no longer see or schedule appointments with Mercy Health providers without an approved Continuity of Care.

Patients were still able to receive care in Mercy hospitals in the case of emergency treatment.

Shortly after this, it was announced that Medicare Advantage patients with Anthem could be affected too, with them losing coverage if a deal was not reached before October 1.

All of this stems from a feud between Mercy and Anthem. Mercy Health previously told 21 News that their reimbursement rates from Anthem's parent company, Elevance Health have not kept up to pace with rising costs of labor, supplies and medications, which in turn would undermine their ability to provide care.

Anthem had fired back accusing Mercy of "terminating its contract to serve a vulnerable population to try to force higher costs."

Mercy then fired back at Anthem accusing them of "no-pay-slow-pay" tactics, outlining these tactics in a lawsuit filed against Anthem in Henrico County, Viriginia.

Details of the agreement are not being released because of confidentiality provisions in the contract. As part of the agreement, Mercy Health has agreed to dismiss the Virginia lawsuit.

Anthem members may contact the Member Service phone number on their Anthem ID card for any questions. Mercy Health patients may also call 888-354-0205 for more information.