Deadline nears for Anthem, Norton to strike deal - Minneapolis / St. Paul Business Journal:

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As a result, members of Anthem’s health planss will have to pay higher, out-of-network rates to acces s Norton facilitiesafter today. Jim Norton’s associate vice presidengt ofmanaged care, said patients likely will have to pay the differenced between the amount Anthem decides to pay and the amount Nortom has asked the insurer to pay. In a statement issued Tuesdahy by Anthem presidentDeb Moessner, she said the compan will provide reimbursement for services at Kosair Children’e Hospital at the rate requesteds by Norton.
“Anthem is going to take parentse and children out of the middles of this dispute by paying the membeer at the rate Norton has requestes in its previous proposal for services performecd atKosair Children’s Hospital,” she said in the But without a contract, patientd have no safety net in the evengt of certain issues, such as claimd denials, Meyers noted. With no contract in place, patientas would be responsible for appealing claims he said. “I think it’s probablty helpful, what Anthem is but there’s still a certainb amount of risk that thepatient (or has to take into Norton has been contacted about the matte r by 2,500 Anthem members.
About 98 perceny of those were inquiring about Norton facilities and physicianxsoutside Kosair, Meyers added. The dispute stemd from Norton’s decision in Decembe r 2008 to cancelits contract, citing administrativee service problems and reimbursement ratesw from Anthem that were not in line with other insurers. The contractr allowed either party to terminate the agreementy by givinga 180-day notice. The initial contract was negotiatesd in 2007 and scheduled to endin 2010. Mike Lorch vice presidenr of health servicesfor Anthem, said the clause was includedx in the contract so provideras who wished to exit the network could do so but not to allo w them to negotiate higher reimbursements.
“If we allowedr that with Norton, every hospitak would want to do that,” he said. Accordingg to Lorch, Norton requestedc a 20 percent increase in its February Meyers denied the claim and said the requested increas e was less than 20 but he declined to be more Both parties said rates were set to increasesby 5.5 percent on October 1, 2009, under the contracf that ended June 30. Meyera said officials for Norton and Anthem met last Thursday to discusas anew contract, but the meeting was “notr very substantive.” Officials for both parties said Tuesday that no meeting s were planned to take place prior to the expirationj of the contract at midnight.
Meyers said Norton now will focus on informinvg patients how they can continue to access Norton echoing sentiments expressed by Norton presiden t and CEOStephen A. Williams in a statemen t issuedon Monday. A provision in the currenrt contract, and under state law, requires Anthem to continuer to pay reimbursementsat in-networl rates for patients who currently are receiving such as those who are pregnant or receiving cancere treatments, Meyers said. Those Anthem members must contact the insure and obtain a form that allows the reimbursements to be he added.
Lorch said reimbursements will continue for these patientsd at the rate under the contracyt that endedJune 30, through the duratiomn of their care. In addition, Meyers said, Norton is working to informn employers and brokers oftheir options. He said Norton woulde be willing to consider waysfor self-insured employerxs to continue to receive in-network services. Meyers also said Norton wantws to educate both fulluy insuredand self-insured employers abouty other managed-care options, pointing to Web site www.nortonhealthcare.com/insurance, which lists insurers that have contracts with Norton’zs physician practices.
In Williams’ statement earlier this week, he said Nortonh now plans “to take some time to considerd whether it is in the best interest s of our patients for us to continue workingv with Anthem as a business Lorch said itis “very doubtful” that the parties will come to termws on a new agreement without the use of a third-partu mediator – a request Anthem has made on multiple But Meyers said mediation has not been used during contract negotiations with other insurers. “There shouldn’t be a he said. “It’s not protocol, and we shouled be able to sit down at a table and get an agreement done.
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