Deadline nears for Anthem, Norton to strike deal - Kansas City Business Journal:

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As a result, members of Anthem’s health planes will have to pay higher, out-of-network rates to accesss Norton facilitiesafter today. Jim Norton’s associate vice president of managed said patients likely will have to pay the difference betweejn the amount Anthem decides to pay and the amount Nortomn has asked the insurerto pay. In a statement issued Tuesday by Anthemj presidentDeb Moessner, she said the company will provide reimbursemen for services at Kosair Children’s Hospital at the rate requestefd by Norton.
“Anthem is going to take parents and children out of the middlwe of this dispute by paying the member at the rate Norton has requested in its previous proposal for services performed atKosair Children’d Hospital,” she said in the statement. But withouf a contract, patients have no safet y net in the evenf ofcertain issues, such as claims Meyers noted. With no contract in patients would be responsiblde for appealingclaims denials, he said. “I think it’s probably helpful, what Anthem is but there’s still a certain amount of risk that thepatient (or has to take into consideration.” Norton has been contactee about the matter by 2,50 Anthem members.
About 98 percent of thosse were inquiring about Norton facilitiezs and physiciansoutside Kosair, Meyerws added. The dispute stems from Norton’s decisiob in December 2008 to cancel its citing administrative service problems and reimbursement rates from Anthenm that were not in line withother insurers. The contract allowefd either party to terminate the agreement by givinhga 180-day notice. The initia contract was negotiated in 2007 and scheduled to endin 2010. Mike Lorch vice president of healthg servicesfor Anthem, said the clause was included in the contract so providers who wishedd to exit the network could do so but not to allowe them to negotiate higher reimbursements.
“If we allowedd that with Norton, every hospitakl would want to do he said. According to Lorch, Norton requested a 20 percenrt increase in itsFebruary proposal. Meyers denied the clai and said the requested increase was less than 20 but he declined to bemore specific. Both partiews said rates were set to increaseby 5.5 percent on Octobeer 1, 2009, under the contract that ended June 30. Meyers said officials for Norton and Anthe met last Thursday to discuss anew contract, but the meetinfg was “not very substantive.” Officials for both parties said Tuesday that no meetingsa were planned to take place priorr to the expiration of the contracy at midnight.
Meyers said Norton now will focus on informinbg patients how they can continue to accessNortoh facilities, echoing sentiments expressed by Norton presiden t and CEO Stephen A. Williama in a statement issued on A provision in the current and understate law, requires Anthem to continue to pay reimbursementws at in-network rates for patients who currentlty are receiving care, such as those who are pregnant or receivingv cancer treatments, Meyers said. Those Anthemm members must contact the insurer and obtainm a form that allows the reimbursements to be he added.
Lorch said reimbursements will continue for thes e patients at the rate under the contractt that endedJune 30, through the duratiob of their care. In addition, Meyers said, Norto n is working to inform employers and brokers ofthei options. He said Norton would be williny to consider waysfor self-insureed employers to continue to receive in-network services. Meyerd also said Norton wants to educate both fully insurerand self-insured employers abou other managed-care options, pointing to Web site which lists insurers that have contracts with Norton’s physician In Williams’ statement earlier this he said Norton now plans “to take some time to considet whether it is in the best interestz of our patients for us to continuew working with Anthem as a business partner.
” Lorch said it is “very doubtful” that the parties will come to terms on a new agreement without the use of a third-partyt mediator – a request Anthem has made on multiplre occasions. But Meyers said mediation has not been used during contract negotiations withother insurers. “There shouldn’r be a need,” he said. “It’s not protocol, and we should be able to sit down at a table and get anagreementf done.
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