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As a subscriber you can listen to articles at work, in the car, or while you work out. Subscribe NowContract talks that started months ago between St. Francis Hospital’s parent company and Anthem Blue Cross and Blue Shield are becoming more contentious – a situation that could lead to a breakup.
Anthem, a unit of Indianapolis-based WellPoint Inc., this week notified some of its business clients that its relationship with Mishawaka-based Sisters of St. Francis Health Services Inc. could come to an end as early as May 1.
St. Francis operates hospitals in Beech Grove, Indianapolis and Mooresville, as well as in eight other cities in Indiana. St. Francis has not disclosed how many of its patients are insured by Anthem and could be affected by the contract dispute.
Statewide, Anthem claims more than 40 percent of all patients, the company reported last month.
The insurer is accusing the system of billing Anthem for services performed outside a hospital at rates for in-hospital services, a practice that leads to higher reimbursements.
“This practice, commonly referred to as ‘billing under arrangements,’ is a violation of our contract and has resulted in millions of dollars in additional health care costs,” Rick Rhodes, Anthem’s regional vice president of local group sales, said in the statement.
St. Francis retaliated with a statement of its own that said, “We are dismayed by Anthem’s display of disinformation.”
“Anthem’s claim that [St. Francis] has breached our current contracts by ‘billing under arrangements’ is patently untrue,” the hospital said in the release. “Anthem’s questionable negotiating tactic unfairly singles out St. Francis for using legitimate service arrangements.”
Anthem said those arrangements are permitted under its contract with Anthem and “have been for decades.”
Last year, St. Francis threatened to cancel its contract with Anthem, accusing the insurer of being slow to pay claims and unwilling to allow the hospital reimbursement rates similar to those given to other hospitals in the Indianapolis area.
The two parties jointly announced in November that they had made progress in negotiating a new multi-year contract and would continue their discussions until an agreement is reached.
Anthem said St. Francis sought a 50-percent increase in reimbursement rates, which would have passed higher costs to Anthem customers.
The hospital filed suit against Anthem Nov. 13 in Marion Superior Court, charging that the insurer breached its contract by failing to timely pay claims.
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