No New Talks Set In Norton-Anthem Impasse (UPDATE)

by Rick Howlett on June 30, 2009

The contract between Louisville’s largest heathcare system and Kentucky’s largest health insurer ended this morning with no new agreement.

No new talks are scheduled between Norton Healthcare and Anthem Blue Cross/Blue Shield. As of July 1, Norton hospitals and services are no longer included in the Anthem coverage network, with the exception of Kosair Children’s Hospital.

Norton Associate Vice-President of Managed Care Jim Meyers says that doesn’t mean all Anthem patients will immediately have to pay out-of-network costs. Many would fall under a ‘continuation of care’ provision.

“It’s both state law and in the contract that allows them to continue to come to our facilities for a period of time. It differs from state to state. But they would still be able to come here as in-network rates and we’d be obligated to accept the previous rates from the old contract,” Meyers said Tuesday.

Norton officials say they want Anthem to pay higher reimbursement rates and improve its administrative procedures. Anthem says the rate hike Norton wants is too high. Norton has declined to disclose the amount of the increase it wants.

Anthem announced late Tuesday it would pay the higher rate requested by Norton at Kosair only.

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{ 2 comments }

Julie Mills July 1, 2009 at 9:21 am

This statement is misleading: “Norton hospitals and services will no longer be included in the Anthem coverage network, with the exception of Kosair Children’s Hospital.” I am an Anthem policyholder and have been told that Anthem will pay in-network benefits at Kosair, but that I should expect to be billed by Kosair for the differnce between their rates and Anthem’s payment. Below is exactly what I received from Anthem:

If you use Kosair Children’s Hospital for care, the services will be covered at in network rates. However, you may be subject to amounts over and above Anthem’s allowed amounts. (The provider may balance bill you.)

I have also inquired whether Baptist or Jewish intended to expand their pediatric services to meet this need and have been told they have no intention to do so.

Rick Howlett July 1, 2009 at 10:34 am

Thanks for writing, Julie.

Anthem agreed late Tuesday to pay the higher reimbursement rate requested by Norton at Kosair only. My understanding is that means that parents of Kosair patients won’t have higher out-of-pocket costs. We’ll follow up on this.

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