By: Health Insurance
Submitted: 2009-10-21 11:50:37 | Word Count: 772
Roughly a quarter-million Anthem insurance customers in the Louisville area can once again go to Norton Healthcare doctors and hospitals without paying out-of-network fees The two companies announced Monday that they have signed a new contract, effective immediately, that puts Norton — Louisville’s largest hospital company — back in Anthem’s network, after an absence of more than three months.
The agreement ended what may have been the most widespread disruption of health-insurance coverage the Louisville area has ever experienced.
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While the companies would not disclose details of the new contract, the main points of contention had been Norton’s demands for higher reimbursements and quicker payments and claims resolution by Anthem.
“I’m just happy that it’s over. It makes my life a whole lot easier,” said Sue Hazelip of Louisville, a Norton cancer patient who has an Anthem Medicare supplemental plan but had been considering changing insurers.
In a joint statement the companies released Monday, Norton CEO Stephen A. Williams said, “We recognize how difficult the out-of-network situation has been for our Anthem patients” and for doctors, employers and others.
He and Deb Moessner, Anthem’s Kentucky president, said both companies are “very pleased” about what she described as a “fair agreement.”
The new agreement means that Anthem and Blue Cross members again can go to Norton doctors and hospitals — including Kosair Children’s Hospital, the region’s only pediatric hospital — and pay in-network co-payment and deductible amounts.
They had been subject to more expensive out-of-network payments since Norton and Anthem severed relations July 1.
The deal is important because Norton provides roughly half the health care in Louisville. It operates five of the city’s nine hospitals and numerous urgent-care centers and employs about 300 physicians.
Unable or unwilling to pay higher amounts to keep using Norton after July 1, many Louisville-area patients reluctantly switched doctors and hospitals. Now they can return to those providers, if they choose.Kentucky Gov. Steve Beshear, who last month publicly scolded the two companies for their protracted standoff, congratulated them Monday on their agreementThe result will be that thousands and thousands of Kentuckians — particularly children — will be able to continue looking to these two vital institutions for their health care needs,” Beshear said in a statement.
Chris Poynter, a spokesman for Mayor Jerry Abramson, said the mayor, who was out of town Monday, was “very pleased that both parties were able to sit down at the negotiating table and come up with a resolution” — and that families no longer have to worry about switching doctors.
Roots of dispute go back years
Though the Norton-Anthem dispute only became public a few months ago, its roots are deeper.
Last December, less than halfway into a three-year contract that began October 2007, Norton gave Anthem the required six-month notice that it would end the contract July 1.
The reason, it said, was a record of slow payments and difficult claims resolution by Anthem. But that wasn’t the only issue for Norton: the company also demanded a double-digit increase in reimbursements.
Anthem balked. It noted that the companies’ three-year deal already called for annual raises — including a 5.5 percent increase scheduled for Oct. 1 of this year — and said the prices the insurer charged customers were based on the scheduled rates.
But Norton said the scheduled increase wasn’t sufficient, and that Anthem should pay what other insurers had agreed to in recent contracts.
On July 1, Norton withdrew from Anthem’s network, leaving many people in the Louisville area with a difficult choice — pay more for Norton services or find other health-care providers.
Norton said the number of Anthem patients admitted to its hospitals fell about 40 percent in the weeks after its split from Anthem.
As a result, Norton’s competitors —Jewish Hospital & St. Mary’s HealthCare, Baptist Hospital East, and UofL Health Care — said their hospitals and physician offices gained patients. Those three organizations remained in Anthem’s network and said they didn’t have particular service problems with the insurer.
