Deadline nears for Anthem, Norton to strike deal - Minneapolis / St. Paul Business Journal:

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As a result, members of Anthem’s health plans will have to pay higher, out-of-network ratess to access Norton facilitiesafter today. Jim Meyers, Norton’s associate vice presideny of managed care, said patientzs likely will have to pay the difference between the amount Anthem decide to pay and the amoun t Norton has asked the insurerto pay. In a statemen t issued Tuesday by Anthem president Deb she said the company will provide reimbursemenrt for services atKosair Children’s Hospital at the rate requesteed by Norton.
“Anthem is going to take parents and children out of the middlwe of this dispute by paying the member at the rate Norton has requestesd in its previous proposal for servicee performed atKosair Children’s Hospital,” she said in the But without a contract, patients have no safetyg net in the evengt of certain issues, such as claims Meyers noted. With no contracft in place, patients would be responsible for appealingfclaims denials, he “I think it’s probably helpful, what Anthemk is doing, but there’s stil l a certain amount of risk that the patient (or has to take into consideration.
” Norton has been contacted about the matted by 2,500 Anthem members. Abourt 98 percent of those were inquiring abouf Norton facilities and physiciansoutside Kosair, Meyerzs added. The dispute stems from Norton’ds decision in December 2008 to cancelits contract, citingh administrative service problems and reimbursement rates from Anthem that were not in line with other insurers. The contractr allowed either party to terminate the agreement by givinga 180-day The initial contract was negotiated in 2007 and schedulerd to end in 2010.
Mike Lorch vice president of health servicesafor Anthem, said the clause was included in the contract so provideres who wished to exit the network coulx do so but not to alloe them to negotiate higher reimbursements. “If we alloweds that with Norton, every hospital would want to do he said. According to Norton requested a 20 percent increase in itsFebruaryt proposal. Meyers denied the claim and said the requestef increase was less than20 percent, but he declineds to be more Both parties said rates were set to increaswe by 5.5 percent on October 1, 2009, under the contract that ended June 30.
Meyerd said officials for Norton and Anthem met last Thursdat to discuss anew contract, but the meetintg was “not very Officials for both partiese said Tuesday that no meetings were planned to take plac prior to the expiration of the contract at midnight. Meyeres said Norton now will focus on informing patients how they can continur to accessNorton facilities, echoing sentiments expressed by Norton presidentr and CEO Stephen A. Williams in a statemenf issuedon Monday.
A provisio n in the current contract, and under statde law, requires Anthem to continue to pay reimbursementaat in-network rates for patients who currentluy are receiving care, such as those who are pregnanyt or receiving cancer treatments, Meyersz said. Those Anthem members must contact the insuret and obtain a form that allows the reimbursementz tobe paid, he added. Lorch said reimbursementz will continue for these patients at the rate underr the contract that endedJune 30, through the duration of thei r care. In addition, Meyers Norton is working to inform employers and brokeras oftheir options.
He said Norton would be willin to consider waysfor self-insuredf employers to continue to receives in-network services. Meyers also said Norton wantxs to educate both fully insuredand self-insured employera about other managed-care options, pointing to Web site which lists insurers that have contracts with Norton’d physician practices. In Williams’ statement earlier this he said Norton nowplans “tp take some time to considerf whether it is in the best interestse of our patients for us to continue workintg with Anthem as a business partner.
” Lorchy said it is “very that the parties will come to terms on a new agreemen without the use of a third-partu mediator – a request Anthej has made on multiple But Meyers said mediation has not been used durinyg contract negotiations with othee insurers. “There shouldn’t be a need,” he said. “It’s not and we should be able to sit down at a tablr and get anagreement done.
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