Nicole Aimone, Editor-in-Chief
As of April 1, area Anthem Blue Cross Blue Shield insurance holders will no longer receive in-network treatment at Sauk Prairie Healthcare Hospitals and Clinics, after the health system and insurance company could not come to an agreement to continue providing covered services.
This contract termination will affect roughly 2,700 patients, or approximately 7% of Sauk Prairie’s patient population, according to the healthcare system.
This termination will also affect patients who visit Sauk Prairie Healthcare’s Plain and River Valley Spring Green clinics.
While patients will no longer be able visit Sauk Prairie Healthcare clinics or hospitals for in-network routine care services, members can still utilize Sauk Prairie facilities for in-network emergency treatment, as Anthem Blue Cross Blue Shield considers any emergency treatment as in-network.
Sauk Prairie Healthcare is urging patients to call the number provided on their insurance cards to determine how their plans are affected. This includes Anthem Blue Cross Blue Shield Medicare supplement plan holders.
“This is very disruptive and stressful to patients. We believe that it would only be right for Anthem to allow enrollees to stay with their providers through the end of their benefit year,” said Amy Ryan, a spokesperson for Sauk Prairie Healthcare. “However, Anthem is neither required nor chooses to do so.”
Ryan says certain patients can apply for a Continuity of Care option, which has to be approved by Anthem, but would allow the patient in-network provider benefits for an additional 90 days.
Anthem Blue Cross Blue Shield policy holders can utilize the Find Care tool at www.anthem.com to search for local doctors and hospitals that accept their insurance plan.
Additionally, area patients can find in-network care facilities, providers and hospitals through Aspirus Divine Savior Hospital in Portage, UW Health University Hospital in Madison, UnityPoint Health — Meriter in Madison, Reedsburg Area Medical Center and SSM Health St. Clare Hospital in Baraboo.
It’s unclear as to which organization chose to end the agreement, as both say it was the other.
A Sauk Prairie Healthcare spokesperson said Anthem terminated the existing agreement, after both parties were unable to come to an agreement on reimbursement levels, saying that Anthem’s first and final offer were below the hospital’s cost increases.
The health system’s final offer before the contract ended reflected an estimated 4-5% overall increase to reimbursement. The health system also claims Anthem was requiring increased burdens that added cost, without considering patient needs and decreasing costs.
“The fair and reasonable increase we asked for is needed to retain team members and keep healthcare in the local community. And keeping it local is a reinvestment in the community. How is Anthem investing in our community? They’re not,” said Ryan. “Anthem is focused on creating maximum value for their shareholders while penalizing patients.”
The health system said over the final two months of negotiations on this issue, their offer has continued to decrease, but Anthem’s did not change.
Anthem Blue Cross Blue Shield Spokesperson, Mike Bowman, claims Sauk Prairie Healthcare chose to leave the network, when the insurance company would not agree to significantly increase healthcare costs for its members, employers and families in Sauk County.
“It is concerning that Sauk Prairie leadership would choose to leave our care provider network,” said Bowman. “Despite our ongoing commitment and repeated attempts to reach a new agreement and meet Sauk Prairie’s demands…they have rejected all offers and remain steadfast in their efforts to significantly increase local health care costs for Anthem members, employers and families in the County.”
Bowman says the insurance provider’s offers included reasonable and fair reimbursement terms for services at their facilities that are in line with those accepted by other health systems, but Sauk Prairie rejected all offers.
The March 31 contract end date was the product of an extension to negotiations, as the original contract between the two organizations was set to expire Dec. 31, 2023.
Ryan says the two organizations negotiated for six months prior to the original end date in December, and agreed to extend the negotiations to March, as they neared an agreement.
“Despite us moving further in their direction, they did not budge from their position over the final two months of negotiations,” said Ryan.
Prior to the March 31 date, Anthem Blue Cross Blue Shield said they offered an additional extension to the existing contract, but Bowman said the health system rejected that offer.
Ryan says Sauk Prairie Healthcare has experienced down-to-the-wire negotiation before, but this is the first time it has not been able to come to a mutual agreement.
The financial implications of using out-of-network providers can vary by plan, so members should contact the insurance provider to determine those costs. Additionally Sauk Prairie Healthcare can provide price estimates prior to scheduling appointments.
The health system says they’ve heard from many patients and community members that they are anxious and confused in navigating what their healthcare options are, and have expressed that Anthem has not been helpful in this transition.
“I am deeply troubled by Anthem’s decision to terminate our agreement, as it has caused significant disruption and stress for both patients and their care teams. Many patients have relied on our hospital clinics for generations, and now find themselves unable to access their trusted providers. The emotional toll on both our team and our patients is palpable,” said Shawn Lerch, CEO of Sauk Prairie Healthcare. “It’s disheartening to see Anthem disregard the longstanding relationships between patients and their healthcare providers, especially in rural areas where alternative options may be limited. As healthcare professionals, our primary focus is on the well-being of our patients, and it’s disappointing that Anthem’s actions seem to disregard the importance of local access to healthcare. Instead, Anthem has chosen shareholder profits over the health and wellness needs of our neighbors, friends, and community members.”
Sauk Prairie Healthcare says it is committed to future good faith negotiations to reach a new agreement that supports the needs of area patients and the health system’s team.
Bowman, Anthem’s spokesperson, said the company is committed to protecting affordability for its customers, “and we hope Sauk Prairie shares that commitment.”
In addition to a variety of letters, emails and signs posted in physical locations, Sauk Prairie has held two Medicare information sessions, and is reviewing its financial assistance policy for all patients in an effort to assist patients with high out-of-pocket costs.
The health system has contacted, and will continue to contact Anthem patients with appointments scheduled to inform them of the loss of coverage.
Additionally the health system has set up a helpline specifically for Anthem patients to navigate this situation, which can be reached at (608) 643-4111.
This story has been updated from print to reflect that the loss of in-network coverage is immediate.
