Bon Secours Virginia has given notice to Anthem Blue Cross Blue Shield that it plans to terminate its physician and facility contracts with the insurer, effective Nov. 7.
If negotiations are unsuccessful, Anthem-insured patients would have to pay out-of-network fees to use physicians and facilities that are part of the Bon Secours network.
"They would still have access to our facilities but their co-payments would be increased," said Lynne Zultanky, Bon Secours Hampton Roads spokeswoman. She added that emergency care falls under an exception and would not be affected.
A letter sent to Hampton Roads participating physicians, signed by Michael K. Kerner, chief executive officer of Bon Secours Hampton Roads, said Mary Immaculate Hospital and Mary Immaculate Ambulatory Surgery Center in Newport News were among the facilities that would be affected.
"Negotiations are ongoing. Our hope is that we resolve it and our patients will have access to uninterrupted care," Zultanky said, emphasizing that nothing would change in the interim.
Anthem is the largest health insurer in Virginia with 3 million subscribers in the state.
"Any given day we're negotiating with hundreds of providers. The vast majority occur behind closed doors. The usual sticking points are reimbursements," said Scott Golden, Anthem spokesman.
Negotiations with Bon Secours have been in an 11-month stalemate. Bon Secours cited a reduced reimbursement rate in addition to issues raised by Affordable Care Act plans purchased through the state's marketplace. In the Richmond market, HCA Virginia hospitals are the preferred provider for those Anthem plans.
In Hampton Roads, Anthem "eventually assigned our facilities to be in Tier I for their Health Insurance Exchange network in Hampton Roads," according to Kerner's letter. Tier I affords the greatest benefits — with lower deductibles and co-pays — Zultanky said.
However, Kerner added that the proposed reduction in total reimbursements over the next three years would "threaten the financial future of our Hampton Roads hospitals." He added, "As Virginia's only faith-based provider of health care, we simply do not have the depth of financial resources to absorb these deep cuts."
Golden dismissed the ACA plans as a factor. "The sticking points are reimbursements and administrative methodologies," he said. "We're still tallying the numbers on ACA enrollment. We're satisfied with them but they're not a significant portion of our business."
Riverside Health System, headquartered in Newport News, reported a similar negotiation deadlock, but has not sent a letter to its physicians. Its contract with Anthem expired in December 2013, but has been extended twice, according to spokesman Peter Glagola.
"We have been negotiating in good faith for the past 15 months," he said. "At this time we have not come to terms and we are uncertain if there will be another contract extension." The current extension expires July 31.
Glagola said Riverside is also on course to send a letter of termination. Golden, however, said Anthem anticipates reaching an agreement in the next 30 to 45 days, and said the insurance company has had a "great relationship" with Riverside over a number of years.
Anthem had a similarly public spat over contract negotiations with Children's Hospital of the King's Daughters in Norfolk in 2011, when both sides sent out letters. In that case, agreement was reached before there was any interruption in access to in-network care.
Salasky can be reached by phone at 757-247-4784.Copyright © 2015, The Baltimore Sun