Anthem Blue Cross Blue Shield is out of network with 11 CommonSpirit hospitals in Colorado.
The contract between Anthem BCBS of Colorado and Chicago-based CommonSpirit expired April 30. The split leaves more than 40,000 CommonSpirit patients in Colorado with Anthem insurance out of network, according to CommonSpirit's website. Anthem is now out of network with most of the system's hospitals in the state and dozens of clinics and practices.
The split affects commercial and Medicare Advantage members, an Anthem spokesperson told Becker's.
In a statement on its website, CommonSpirit said it is "ready and willing to continue working toward a new agreement with Anthem."
Anthem's proposals "failed to offer terms that fairly reimburse for services provided to its members, and equitably cover the burden to get reimbursed timely and accurately," CommonSpirit said.
"We need Anthem to acknowledge what is at stake for patients and agree to contract terms that will allow us to retain healthcare professionals, ensure access to providers and continuity of care, sustain and introduce new services to the community, invest in technology, and maintain our premier facilities throughout the state," the system said.
A spokesperson for Anthem told Becker's the insurer proposed a "multi-year agreement that includes reasonable reimbursement rates."
"Unfortunately, CommonSpirit has chosen to leave Anthem's network in Colorado. Anthem continues to collaborate with CommonSpirit to reach a new agreement," the 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."
Nationwide, disputes between payers and providers are on the rise. Contract negotiation disputes between payers and providers that were reported in the media increased by 69% between 2022 and 2023, according to data published by FTI Consulting in January.
In a May 1 news release, Colorado Insurance Commissioner Michael Conway urged CommonSpirit and Anthem to continue working toward an agreement.
"Unfortunately, Coloradans are the ones caught in the middle when large health systems and large insurers fail to reach an agreement," Mr. Conway said. As Anthem and CommonSpirit continue to work towards a new agreement, they must be cognizant that increased healthcare costs are ultimately borne by those same consumers in increased premiums."