Anthem is notifying customers that they might not be able to get care from Akron Children’s Hospital without paying higher out-of-network rates beginning Jan. 1.
In a letter mailed recently to members, Anthem indicated that Children’s is terminating its contract with the insurer for its hospitals, physician practices, emergency departments, home care and other services unless a new reimbursement deal can be reached. The two sides are continuing to negotiate.
Children’s contract also covers its neonatal intensive-care units at Summa Akron City Hospital and Akron General Medical Center and its pediatric units at Robinson Memorial Hospital in Ravenna, Aultman Hospital in Canton and Wooster Community Hospital.
Most insurance plans require consumers to seek services from in-network health-care providers to pay the lowest out-of-pocket charges.
Kevin Batty, a father of three from Green, said he’s concerned his family might lose access to the nearest pediatric hospital, as well as their pediatrician, who is employed by Children’s.
His employer recently renewed a contract with Anthem for employee health insurance coverage in 2014.
“It’s going to affect people — a lot of people,” he said. “What I would like to see is them sit down and find a middle ground and hammer out a new contract.”
Anthem is among the region’s largest insurers, with nearly 3 million members throughout Ohio.
Karen Richter, vice president of managed care for Children’s, said the hospital was required to give a 180-day notice to Anthem this summer that it wanted to renegotiate the current contract, rather than continuing another year with the same terms.
Anthem is among the top five private payers for Children’s.
“The intent all along is to work out a mutually agreeable relationship,” she said. “We’ve always been able to do it in the past, and it’s our expectation that we’ll do it now. It’s just taking a little longer this time.”
Negotiations are continuing, said Richter, who acknowledged the hospital is hearing from concerned families who don’t want their children’s medical care disrupted.
“Our No. 1 goal is that we remain a participating provider with Anthem, that we’re accessible to all the kids we’re privileged to serve here,” she said. “ … We’re doing everything we can to resolve this while, at the same time, making sure the resolution allows us to continue to be a hospital that continues to serve the community.”
Issues include payment rates, along with other undisclosed terms and conditions of the contract, Richter said.
Anthem spokeswoman Deborah Wiethop said the insurer also is committed to continuing discussions.
“We still hope we can reach an agreement to avert a network disruption,” she said.
If a deal can’t be reached by the end of the year, families of children who are in the middle of a course of treatment can contact Anthem’s member services for options, Wiethop said. “We’ll get them in touch with the right person for a possible continuation of care benefit.”
Anthem sent letters late last week to all of its members who received services from Children’s within the past 12 months, Wiethop said. She declined to say how many people are potentially affected.
In the letter, Anthem includes a list of other in-network pediatric hospitals throughout the region with affiliated specialists, including Rainbow Babies and Children’s Hospital in Cleveland, Children’s Hospital of Pittsburgh and the Cleveland Clinic Children’s Hospital.
“We know that there is a children’s hospital within a two-hour drive of every child in the state of Ohio,” she said.
Children’s is posting the latest information about the contract situation on its website, www.akronchildrens.org, under the link “Anthem update.”
Families also can send their questions via email to insurance@chmca.org or call 330-543-5190.
Cheryl Powell can be reached at 330-996-3902 or cpowell@thebeaconjournal.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.