Matthew Sanders
COLUMBIA, Mo. (KMIZ)
A leader of the Missouri Senate said Tuesday that she wants MU Health Care to accept terms offered by insurer Anthem Blue Cross Blue Shield by the end of the week.
“This contract needs renewed this week,” Senate President Pro Tem Cindy O’Laughlin (R-Shelbina) wrote on Facebook. “I have contacted a few other senators to get their input and they agree; sign the contract. Yes I know that I am not on the inside nor the CEO of either but from what I’ve been told this seems a reasonable offer. I’m encouraging the contract be signed by Thursday so the thousands of people insured and seeking access to their doctors can once again resume their healthcare.”
O’Laughlin and other lawmakers held a committee hearing last week to talk with Anthem and MU Health leadership about the contract dispute.
Anthem customers using Medicare Advantage plans have been out of MU Health Care’s network since February. Other customers have been out of network since April, after the two parties failed to reach an agreement for a new contract. MU Health has said Anthem is slow to pay claims and wants too high a reimbursement rate. Anthem maintains that it can’t afford higher reimbursement rates.
Anthem, which covers about 90,000 MU Health patients, gave two new offers during last week’s hearing. O’Laughlin wants MU Health to take one of them.
“Anthem doubled their rate increase offer,” O’Laughlin wrote. “They also will allow policy exceptions to remain in place (those exceptions allow MU to receive extra insurance coverage on services.) The Anthem proposal increase includes paying doctors more.”
“These two entities started a long ways apart but I believe it is time to renew. Anthem has come up substantially and there’s too many people negatively affected and going without coverage to see their doctors at MU Health.”
Anthem highlighted its two proposals in a statement and said a follow-up session was held.
“During the recent public hearing, Anthem presented two distinct proposals to MU Health Care in an effort to resolve our contractual differences,” the statement says. “In a private session following the hearing and again as recently as yesterday, we extended an additional offer aimed at moving toward a resolution. Our goal remains clear: to restore MU Health Care to our network at rates that preserve access while keeping coverage affordable for all Missourians, including those covered by the Missouri Consolidated Health Plan.”
MU Health Care also confirmed it’s been in communication with Anthem since the hearing.
“MU Health Care and Anthem have been in active conversations since the hearing last Monday, and we received a proposal from Anthem late yesterday afternoon. Our goal remains to reach an agreement and return in-network access for Anthem members to MU Health Care clinicians and facilities,” said MU Health Communications Specialist Rochita Ghosh.
Sandy Smith, a cancer survivor who has relied on MU Health Care since 2016, said she’s had no issues with Anthem until this year.
“I have a condition called Lynch syndrome, which makes me more susceptible to other cancers. And so I don’t feel like I can just go to anybody that’s not familiar with that,” Smith said. “So when I heard that they weren’t renewing the contract, I was just going to wait until the marketplace opened again and then I would have to go with UnitedHealthcare. Any appointments I have from now until the end of the year, I was just going to postpone them until I get different insurance.”
Smith said she called Anthem to try to enroll in continuity of care, but was told she already had a doctor in her town.
“When I look that doctor up, it’s a male and I go to females for my kind of cancer and treatments. And so that was a “no.” And it wasn’t an oncologist gynecologist,” Smith said. “So they think that there’s options, but when you need certain specific doctors and gender it’s not an option. So it is very frustrating and it can be stressful.”
Smith added that while her current care is primarily preventive, the ongoing dispute is much more stressful for patients actively undergoing treatment.
“I’m one of the healthier ones, because all mine are preventative. I think more of the people that are going through cancer treatments right now and having to deal with this, my heart goes out to them,” Smith said. “We are people. We’re not just numbers. And so when you’ve gone through treatments or you’re facing things, you need people with compassion and they need to show some compassion towards us as human beings.”
Rep. Gregg Bush (D-Boone County), a nurse and Anthem customer, said the issue is deeply personal.
“There’s an old proverb that when elephants fight, it’s the grass that suffers,” Bush said. “And what we have is we have Anthem this big institution. We have MU that has been filling the gaps with rural health care, and that when they’re in conflict, it’s the rest of us that are suffering.”
Bush said he moved to Anthem insurance earlier this year and immediately felt the impact.
“It was a little bit of a gut punch, frankly. My family has been using MU Health Care for almost two decades,” Bush said. “In some ways, I don’t want lawmakers kind of involved in this, but we can’t not be. We are talking about the people who assist us throughout the whole Capitol. We’re talking about Missouri State Highway Patrol members. These are the people that serve us, that protect us. And if we have any sort of clout whatsoever, we should exercise it to try to make sure that they get the best care for themselves and for their family.”
Bush also said MU Health Care is vital to rural Missouri.
“MU Health Care has kind of been in the gaps where for-profit health care has fled rural Missouri and MU Health Care has taken up the slack,” Bush said. “We have legislators that come from all over the state. And there’s only one network that is in all the state, and that’s MU Health Care. It’s just the reality.”
He added that Anthem’s for-profit model adds to the burden on patients.
“We have institutions that are basically taking money out of health care and putting it into stock buybacks, taking money out of people’s care and putting it into dividends,” Bush said. “And MU Health Care doesn’t do those kinds of things. They take all of their margin that they’re making and they end up opening clinics in rural parts of Missouri because they’re not allowed to make a profit and pay shareholders.”
Bush said he’s heard from constituents across the state, but the issue also hits close to home.
“I have children that need pediatricians and there’s only one provider in our county that has a network of pediatricians and that’s MU Health Care,” he said. “When they don’t accept Anthem, that’s a significant issue. Now in our health care oasis, which is Columbia, now we’re having to drive two hours to go see a provider.”
As of Tuesday evening, MU Health Care had not indicated whether it would accept the latest proposal from Anthem. O’Laughlin urged the health system to finalize a deal by Thursday. The contract dispute remains unresolved.
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