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CommonSpirit health system dropped from Anthem Blue Cross Blue Shield after two sides fail to reach agreement

Since an agreement has not been reached, Anthem now considers 11 Colorado hospitals and dozens of clinics and practices as out-of-network.
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Posted at 9:34 PM, May 01, 2024
and last updated 2024-05-02 07:48:35-04

LAKEWOOD, Colo. — After failed contract negotiations, more than 40,000 Colorado patients with Anthem Blue Cross Blue Shield insurance no longer have in-network access to nearly all of CommonSpirit’s hospitals, clinics and physicians.

The contract terminated at 11:59 p.m. on April 30, and Anthem removed CommonSpirit from its network beginning May 1.

A spokeswoman for Anthem said the insurance company has offered CommonSpirit a multi-year agreement that includes “reasonable reimbursement rates” but said, “CommonSpirit wants to unacceptably increase costs for Colorado consumers and employers.”

In a news release Wednesday, CommonSpirit said it “proposed a temporary contract extension that would have allowed us to continue to provide in-network services to Anthem members while negotiations continued, but Anthem denied our request.”

Carrie Jolly has suffered from migraines since she was in her teens. She's tried nearly every treatment on the market.

“Nothing was really getting me to the amount of relief that I needed to have to function on a daily basis,” she said.

Jolly finally found that relief with a CommonSpirit provider — an in-network doctor with Anthem Blue Cross Blue Shield Insurance.

“Finally, he's like, 'Well, let's try this other class of medication.' And that was about two years ago. And since then, I have been essentially cured of migraines,” said Jolly.

On April 1, Jolly received a letter from Anthem Blue Cross Blue Shield informing her that CommonSpirit would no longer be considered in-network, putting her treatment in limbo.

“So, what I would end up doing is postponing my care. And it's not just my neurologist, it's also my primary care provider,” said Jolly.

CommonSpirit Chief Medical Officer Oswaldo Grenardo said the health system is doing what it can to prevent the disruption of scheduled surgeries. But without a contract, Grenardo said it's in the hands of Anthem Blue Cross Blue Shield.

“We want to make sure that that doctor-patient relationship is unharmed. Then here's the problem: Anthem, then, has the ability to actually tell us, or approve or deny that,” said Grenardo.

In a statement, an Anthem spokesperson said, "This negotiation is about healthcare affordability. CommonSpirit wants to unacceptably increase costs for Colorado consumers and employers. Healthcare cost increases of this magnitude would directly impact our members and local employers."

Colorado's Division of Insurance is calling on the two sides to reach a deal. The division said Anthem policyholders should call the number on the back of their insurance cards before seeking any care.

“If they assume that everything's going to be okay and they don't call and check, it can work out badly for them on the back end. That's when they'll get some sort of large bill because they went to an out-of-network facility,” said Vincent Plymell, assistant commissioner for communications & outreach at Colorado’s Division of Insurance.

Jolly plans to change her insurance to stay with her current doctor but can't do that until the new year. She also has an appointment scheduled for this month.

“I feel like consumers are in the middle right now,” said Jolly.

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