Anthem Blue Cross and Blue Shield, the largest health insurer in northwest Ohio, will no longer cover most care at St. Luke's Hospital in Maumee and will decrease coverage at St. Charles Mercy Hospital in Oregon starting next year.
Few observers of the Toledo health care market were surprised by the changes, saying Anthem is merely solidifying its existing relationship with ProMedica Health System at the expense of St. Luke's, an independent, and St. Charles, part of the Mercy Health System.
"All they're really doing is tightening their commitment to the ProMedica system," said Benjamin Goff, president of Toledo-based Great Lakes Risk Management. "We have Anthem aligning themselves very strongly with ProMedica and Medical Mutual [of Ohio] aligning themselves very strongly with Mercy. And St. Luke's, God love 'em, is the last independent dog out there."
The changes take effect Feb. 1 for St. Luke's and May 1 for St. Charles, which is owned by Mercy. St. Charles' inclusion in Anthem's network pre-dated the opening of a ProMedica hospital in Oregon.
With ProMedica-owned Bay Park Community Hospital now open, Anthem no longer needs St. Charles.
Emergency care at both St. Luke's and St. Charles still will be covered. Anthem officials said patients still could have access to both facilities through "traditional product" 80 percent-20 percent plans, but Mr. Goff said few people choose those plans because they're far more expensive than other Anthem products.
There are no changes in Anthem's physician network other than Anthem adding about 100 Medical College of Ohio physicians to its network.
St. Luke's officials said the announcement was both surprising and disappointing.
"We hadn't even discussed rates," said Dave Dewey, vice president of marketing for St. Luke's. "They canceled us without any negotiations."
Mr. Dewey said 9 percent of St. Luke's patients were Anthem members last year.
It's not the first time St. Luke's has struggled to keep insurance carriers as Mercy Health Partners and ProMedica, and their affiliated insurance companies, battle for turf. In 2001, ProMedica-owned Paramount dropped most coverage at St. Luke's.
Dr. Donna Woodson, a Maumee family physician with offices near St. Luke's, called the changes "extremely unfortunate for our patients who are losing choice."
Mercy spokesman Megan Manahan said she didn't know how many Anthem patients who typically seek care at St. Charles would be affected.
The three biggest players in the northwest Ohio insurance market are Anthem, Medical Mutual, and Paramount.
Anthem has 250,000 members in a 20-county area of northwest Ohio. It is based in Indianapolis and has 12.6 million members in nine states. Cleveland-based Medical Mutual has about 220,000 members in the same 20-county area as Anthem. Paramount has 191,000 members in 23 counties of northwest Ohio, along with two southeast Michigan counties.
The recent Anthem move means health coverage for many residents will continue to be split between either ProMedica or its main rival, Mercy.
ProMedica hospitals include Toledo Hospital, Toledo Children's Hospital, Flower Hospital in Sylvania, Bay Park, Defiance Regional Medical Center, and Fostoria Community Hospital. Last year, Anthem announced it had signed long-term contract deals with ProMedica and yesterday said those deals had been extended to 2009.
Mercy in 2002 signed long-term deals with Medical Mutual lasting at least 10 years. Mercy hospitals include St. Charles, St. Vincent Mercy Medical Center, St. Anne Mercy Hospital, and Mercy Children's Hospital in Toledo, and hospitals in Willard and Tiffin.
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