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Anthem-Akron Children’s reach agreement

Tuesday, December 24, 2013

By Burton Speakman


Anthem has reached an agreement with Akron Children’s Hospital over reimbursement rates 11 days before area patients could have been left without coverage.

Karen Richter, vice president of managed care for Akron Children’s, said the hospital and Anthem had been in contact nearly every day.

“We are pleased that we were able to reach an agreement with Anthem so we could remain accessible to all of the Anthem-enrolled patient families who rely on our services and providers,” Richter said. “We’re happy our patient families will still be able to access their trusted physicians and have the peace of mind the continuity of care will provide.”

The agreement is good news for a number of parents who had been concerned about negotiations.

Richter said she had been receiving calls from concerned parents daily about the issue.

Anthem had been in negotiations with Akron Children’s for several months, said Kim Ashley, spokeswoman for the company.

“We want to keep Akron Children’s Hospital in our networks,” she said.

The disagreement between the two companies was related to reimbursement rates for services. The hospital was seeking higher rates to cover their costs of offering service, while Anthem stated its goal was to offer a “reasonable” deal for its customers.

Anthem had sent a letter to customers warning about the potential issue, stating, “We’re writing to let you know that we are presently in negotiations with Akron Children’s Hospital, which has chosen to terminate its facility, physician and ancillary network contracts with Anthem Blue Cross and Blue Shield effective Jan. 1, 2014, unless agreement is reached on a new reimbursement contract before that date.”

Anthem had offered rates the company stated were “fair and competitive” and similar to contracts the company has signed with other children’s hospitals in northern Ohio, Ashley said. The rate of the contract impacts what Anthem customers pay for insurance.

The issue is that children’s hospitals have some unique needs, Richter said.

“We’ve had people call in and say we need to forget about the money and think about the children,” she said.

But without proper funding, the hospital will not be able to offer the best quality of care, Richter said. The hospital has an obligation to maintain the top quality of care, she said.

“Anthem and Akron Children’s have had a long-term professional relationship, providing our members with ongoing access to the excellent health care services provided by the hospital and its physicians,” said Jim Pugliese, regional vice president of provider engagement and contracting for Anthem Blue Cross and Blue Shield in Ohio. “This agreement renews our continuing commitment.”