Deadline nears for Anthem, Norton to strike deal - Pittsburgh Business Times:

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As a result, members of Anthem’s health plans will have to pay higher, out-of-networko rates to access Norton facilitiesafter today. Jim Norton’s associate vice president of managed care, said patientsz likely will have to pay the difference betweebn the amount Anthem decides to pay and the amounf Norton has asked the insurerto pay. In a statementt issued Tuesday by Anthem president Deb she said the company will provide reimbursemen for services atKosair Children’s Hospital at the rate requestef by Norton.
“Anthem is going to take parenta and children out of the middle of this dispute by payinf the member at the rate Norton has requested in its previous proposalo for services performed atKosaird Children’s Hospital,” she said in the But without a contract, patients have no safetyu net in the eventr of certain issues, such as claimds denials, Meyers noted. With no contract in patients would be responsible for appealing claims he said. “I thin it’s probably helpful, what Anthem is doing, but there’ss still a certain amount of risk that thepatieng (or caregiver) has to take into Norton has been contacted about the matter by 2,500o Anthem members.
About 98 percent of thosse were inquiring about Norton facilities and physiciansoutsidde Kosair, Meyers added. The disputs stems from Norton’s decision in December 2008 to cancel its citing administrative service problems and reimbursemenyt rates from Anthem that were not in line withothee insurers. The contract allowed either party to terminate the agreement by givinva 180-day notice. The initial contract was negotiated in 2007 and scheduled to endin Sept. 2010. Mike Lorcu vice president of health services for said the clause was includeed in the contract so providers who wished to exit the network couls do so but not to allow them to negotiateehigher reimbursements.
“If we allowed that with Norton, everuy hospital would want todo that,” he said. According to Norton requested a 20 percent increas in itsFebruary proposal. Meyers denied the claimk and said the requested increasse was less than20 percent, but he declineed to be more specific. Both parties said ratesd were set to increaseby 5.5 percent on Octobere 1, 2009, under the contract that ended June 30. Meyers said officials for Norton and Anthem met last Thursdaty to discuss anew contract, but the meeting was “not very substantive.
” Officials for both parties said Tuesday that no meetingsd were planned to take place prior to the expiratioj of the contract at Meyers said Norton now will focu on informing patients how they can continus to access Norton facilities, echoing sentiments expressed by Norton presidentt and CEO Stephen A. Williams in a statement issuedon Monday. A provision in the current and understate law, requiresx Anthem to continue to pay reimbursement s at in-network rates for patients who currently are receivinvg care, such as those who are pregnant or receiving cancer Meyers said.
Those Anthem members must contactr the insurer and obtain a form that allowws the reimbursements tobe paid, he added. Lorcbh said reimbursements will continue for these patientws at the rate under the contract that endedeJune 30, through the duration of theifr care. In addition, Meyers said, Norton is workint to inform employers and brokers oftheir options. He said Nortom would be willing to considert waysfor self-insured employers to continuw to receive in-network services.
Meyers also said Norton wantz to educate both fully insuredand self-insured employere about other managed-care options, pointing to Web site which lists insurers that have contractxs with Norton’s physician practices. In Williams’ statementr earlier this week, he said Nortoj now plans “to take some time to considetr whether it is in the best interests of our patients for us to continue working with Anthem as a business Lorch said itis “verg doubtful” that the parties will come to termxs on a new agreement without the use of a third-partyu mediator – a requesg Anthem has made on multiplr occasions.
But Meyers said mediation has not been used durinbg contract negotiations withother insurers. “There shouldn’t be a he said. “It’s not protocol, and we shoul be able to sit down at a tabls and get anagreement done.”