Anthem Updates

Our commercial contract with Anthem is set to expire on January 1, 2025. For approximately 15 months, we have worked in good faith with representatives from Anthem to align on terms for a new contract that:

• Protects patients by ensuring Anthem members continue to have seamless, affordable, in-network access to the care and services our team members, physicians and other health care professionals provide each and every day.
• Pays us fairly for the hard work our clinicians do and for the investments we make in our people, technology, and facilities, including our hospitals, urgent care, and provider practices.
• Is consistent with reimbursement market rates paid to other health systems in our state for the same services.

While we believe both parties want to reach an agreement, we are disappointed by the terms and unrealistic rates Anthem is asking us to accept at this critical time for our organizations.

It is important to know that we are doing everything possible to avoid this outcome. However, if a new contract is not in place by January 1, Anthem will no longer consider St. Joseph Hospital and affiliated outpatient clinics and medical staff in-network. New Hampshire regulations mandate that patients must be treated as in-network for up to 60 days following a contract expiration. This means that, by law, all patients that have Anthem insurance will be treated as in-network until March 1, 2025.

After March 1, 2025, St. Joseph Hospital would be considered out-of-network and that patients who are covered by Anthem commercial plans may pay higher, out-of-pocket expenses when they receive care at our hospital, outpatient clinics, or provider practices. It is important to note that this will have no impact on members with Anthem Medicare Advantage coverage.

Our current agreement with Anthem expires on January 1, 2025. We want to continue working with Anthem and caring for our patients who are Anthem members. We are hopeful we align on terms for a new contract well in advance of our current contract’s expiration to avoid causing unnecessary stress for our patients and caregivers, as well as to protect our patients from the disruption of Anthem’s out-of-network processes.

Contracts of this magnitude are complex and are influenced by numerous factors. The issues we are most concerned about include:

• Ensuring Anthem agrees to terms that follow industry standard policies regarding claims administration and payment.
• In addition to reducing inappropriate denials for reimbursement, Anthem must provide adequate reimbursement for the services the hospital and our providers.

Over the past several years, contract negotiations between health systems and health insurance companies have grown increasingly complex. While every negotiation process is different, Anthem has a reputation for, and a history of, highly publicized disputes with other health systems across the nation.

Our team has spent months in conversation with Anthem to align on reasonable terms and rates with the goal of ensuring our patients continue to have affordable access to their current providers and the high-quality health care they need, when and where they need it.

• The rates Anthem is offering are lower than those provided to other health systems in New Hampshire. Accepting rates that are out of line with the real cost of delivering care undermines our viability.
• We are also concerned by Anthem’s unusually high rate of denials for reimbursement, as we believe they are unwarranted and overly burdensome. Requiring claims to be submitted multiple times before they are finally approved creates unnecessary stress for our patients and unnecessary expenses for our organizations. We are not alone in this concern, there have been multiple instances of articles published in New Hampshire over the past few years that have highlighted similar concerns with Anthem business practices.

If an agreement is not reached, all commercial plans including Affordable Care Plans administered by Anthem of New Hampshire will no longer consider St. Joseph Hospital in-network. Anthem Medicare Advantage members will not be impacted.

Yes, but Anthem may require them to pay significantly higher out-of-pocket costs to continue seeing the same doctor or clinician they see today. New Hampshire law also requires insurers like Anthem to maintain existing coverage for patients for 60 days if we are unable to come to agreement by January 1, 2025. This means that all patients that have Anthem insurance will be treated as in-network until March 1, 2025.

Fortunately, patients in need of emergency care will still be able to access our emergency department without paying more because emergency care is always considered in-network.

Continuity of care ensures that patients receive consistent and coordinated healthcare services over time. Federal regulations, including those outlined in the Consolidated Appropriations Act, 2021 (CAA), mandate that health plans must offer patients the option to continue care with their current provider if the provider leaves the network during an ongoing treatment. Patients with ongoing medical conditions may be able to receive continuing care and should contact Anthem directly to discuss their individual condition.

It is important to know that we will continue to negotiate with Anthem until our current agreement expires or until the time it becomes clear that Anthem is completely unwilling to consider the needs of its members by offering reasonable rates that cover our costs and protect the viability of St. Joseph Hospital.

Although you may hear more than usual about our discussions with Anthem and other insurance companies, please know that our patients and their loved ones are at the heart of all we do. We will never lose sight of why we are here: to ensure our patients and community remain healthy and have access to the care and services they depend on when and where they need them.

We encourage patients to contact Anthem to let them know that they want Anthem to offer reasonable reimbursement and for St. Joseph Hospital and St. Joseph Hospital Providers to remain in network.

Here are some ways to help:

• Patients can contact their employer’s Human Resource or Benefits Administration department to share their concern regarding a potential change in Anthem’s provider network in the State of New Hampshire.
• Patients can contact Anthem to let them know that it is important that their provider and hospital remain in-network. Anthem can be reached by phone at 1-833-388-1239

We are committed to transparency and to provide regular updates regarding our negotiations with Anthem. Please visit this webpage for updates.