An ongoing contract dispute between Anthem Blue Cross Blue Shield and MU Health Care could potentially leave many without coverage if not resolved by April 1, 2025.
Negotiations are still going on between MU Health Care and Anthem regarding commercial contracts that impact over 100,000 patients. These agreements encompass employer-sponsored plans, Affordable Care Act marketplace plans, and HealthLink coverage.
MU Health Care and Anthem have been involved in a contract dispute primarily revolving around reimbursement rates and the terms of their agreement. The disagreement arose when MU Health Care sought to negotiate increased payment rates for services provided by their hospitals and clinics. Anthem argued that the proposed rates would lead to increased healthcare costs which they argue would affect their ability to deliver high-quality medical care to patients.
The talks so far have led to a serious breakdown between the two parties and now sees the serious potential for many patients to face higher out-of-pocket expenses if the contract were to lapse.
As a result of the dispute, Anthem’s members may experience disruptions in their access to MU Health Care’s services. If the contract is not renewed, patients might have to seek care from alternative in-network providers, potentially limiting their options and impacting continuity of care.
MU Health Care wants to see a rate change between 20-30% over three years to help cover rising costs in the healthcare industry.
“We are doing everything we can to continue our participation in the Anthem network in order to maintain our patients’ in-network access to MU Health Care, but a new, fair network agreement is essential to our ability to provide high-quality, local care to our patients,” said Dr. Steve Whitt, MU Health Care’s chief medical officer. “Physicians and caregivers at MU Health Care wake up every day with the goal of living our mission to save and improve lives. That work is only possible when companies like Anthem step up alongside us through a fair contract that reflects our state’s challenging health care and economic environment.”
Anthem argues that if it were to give into MU Health Care’s demands the increased cost would lead to higher costs for its clients. One example being a premium increase of $1,200 for State employees.
“MU Health Care justified their demands by pointing to other hospital systems and challenges,” stated in an op-ed written by Stephanie Vojicic, president of Anthem Blue Cross and Blue Shield in Missouri.”We agree that costs in health care are rising — but the responsibility of any business is to manage cost pressures and not simply pass them on to those they serve, which is what MU Health Care is seeking to do.
Anthem previously addressed the ongoing negotiations, announcing that MU Health Care will exit its Medicare Advantage network effective April 1.
Current Anthem Medicare Advantage members receiving care from MU Health will soon be informed about their options, which include maintaining continuity of care at MU Health or selecting alternative in-network providers in Columbia and across Missouri.
With the open enrollment deadline for Medicare Advantage set for March 31 and the previous enrollment period for 2025 commercial coverage having closed on January 31—reopening on November 1 for 2026—there are concerns that some patients may postpone routine care until the enrollment period restarts.
The termination of the contract would not only affect those who are employed by the University itself. However, in the chance of a terminated contract, it will not affect Mizzou Pharmacy retail services or patients enrolled in Healthy Blue Medicaid and University of Missouri Student Advantage plans.
Termination would also affect those outside of the university including many in rural communities.
Rural Missouri over the past several years have seen a huge hit in access to quality healthcare
According to the Department of Health and Senior Services “Of the 161 licensed hospitals in Missouri, 67 (42%), including five (5) behavioral health hospitals, are located in rural counties. Of those 67 hospitals, 62 are hospitals with medical/surgical beds, five (5) are behavioral health hospitals, 31 are Critical Access Hospitals (CAHs), which have 25 beds or less and provide a limited scope of service.”
Hospitals in rural communities have seen a major decline. Since 2014, roughly 20 rural hospitals have been closed due to various reasons.
Mizzou has made it clear over the last few days that termination of the contract with Anthem is almost certain to happen. The effects of this cancellation will be felt by more than Columbia but will hurt a great deal of people across mid-Missouri and possibly beyond.
Jake Kroesen is a Jackson County native and a graduate of the University of Central Missouri. He holds a B.S. in Political Science.
