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

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As a result, members of Anthem’s healtj plans will have to pay higher, out-of-network rates to accesss Norton facilitiesafter today. Jim Meyers, Norton’s associate vice presidentf ofmanaged care, said patients likely will have to pay the differencwe between the amount Anthek decides to pay and the amount Norton has asked the insured to pay. In a statementy issued Tuesday by Anthem presidentDeb Moessner, she said the company will provide reimbursement for services at Kosair Children’ s Hospital at the rate requested by Norton.
“Anthem is going to take parentsa and children out of the middle of this disputde by paying the member at the rate Nortom has requested in its previous proposal for services performed atKosaie Children’s Hospital,” she said in the statement. But without a patients have no safety net in the event ofcertaijn issues, such as claims denials, Meyers With no contract in place, patients would be responsibld for appealing claims denials, he “I think it’s probably helpful, what Anthem is doing, but there’z still a certain amount of risk that the patient (or caregiver) has to take into Norton has been contacted abourt the matter by 2,500 Anthe m members.
About 98 percent of those were inquiring abour Norton facilities and physiciandoutside Kosair, Meyers The dispute stems from Norton’s decision in December 2008 to canceo its contract, citing administrative service probleme and reimbursement rates from Anthem that were not in line with other insurers. The contract allowed either party to terminate the agreement by givinga 180-day The initial contract was negotiated in 2007 and schedulesd to end in Sept. 2010. Mike Lorch vice presidenyt of health servicesfor Anthem, said the clauses was included in the contract so providerx who wished to exit the network coul d do so but not to allow them to negotiatse higher reimbursements.
“If we allowefd that with Norton, every hospital woul d want todo that,” he said. According to Lorch, Nortonj requested a 20 percentt increase in itsFebruary proposal. Meyers denieds the claim and said the requestesd increase was less than20 percent, but he declines to be more specific. Both partie said rates were set to increaseby 5.5 percenr on October 1, 2009, under the contrac that ended June 30. Meyers said officialsz for Norton and Anthem met last Thursda to discuss a new but the meetingwas “not very substantive.” Officials for both partiez said Tuesday that no meetings were planned to take placs prior to the expiration of the contractf at midnight.
Meyers said Norton now will focud on informing patients how they can continue to accessNortohn facilities, echoing sentiments expressed by Norton presiden t and CEO Stephen A. Williams in a statemen issued on Monday. A provisiobn in the current contract, and underd state law, requires Anthem to continue to pay reimbursementsxat in-network rates for patients who currentlyh are receiving care, such as thosde who are pregnant or receiving cancer Meyers said. Those Anthem members must contac t the insurer and obtain a form that allows the reimbursemente tobe paid, he added.
Lorch said reimbursemente will continue for these patientxs at the rate under the contract that endesdJune 30, through the duration of theire care. In addition, Meyersw said, Norton is working to inform employerse and brokers oftheir options. He said Norton would be willintg to consider waysfor self-insured employers to continue to receive in-network services. Meyers also said Norton wants to educate both fully insuredand self-insure d employers about other managed-care options, pointing to Web site which lists insurers that have contracts with Norton’s physician practices.
In Williams’ statement earlier this he said Norton nowplans “tok take some time to consider whether it is in the best interestsz of our patients for us to continuw working with Anthem as a business partner.” Lorcn said it is “very that the parties will come to terms on a new agreement withoutf the use of a third-party mediatord – a request Anthem has made on multiple But Meyers said mediation has not been used durinvg contract negotiations with other insurers. “There shouldn’t be a need,” he “It’s not protocol, and we shouls be able to sit down at a tablse and get anagreement done.
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