Mount Vernon News

By Mount Vernon News
February 23, 2013 11:38 pm EST


MOUNT VERNON — Relief may be on the way for area residents who have health coverage through Anthem BlueCross Blue-Shield and have to pay out-of-network fees for healthcare in Knox County. Knox Community Hospital, on behalf of its hospital-employed physicians, and Anthem have finally resumed negotiations concerning reimbursement for physician services.


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Bruce White, KCH chief executive officer, said he met with Anthem representatives on Tuesday. Although unable to reveal specifics, White said he is hopeful an agreement with Anthem can be reached.

“We ask for nothing more than fair market reimbursement rates and a level playing field for all our insurance payor partners,” he said. “The vast majority of the payors in this area (including Cigna, United HealthCare, Medical Mutual and Aetna) have understood and agreed. I am very pleased to have now had this recent meeting with Anthem and I hope we can come to a similar, mutually agreed-upon partnership.”

White estimated the current impasse impacts approximately 3,600 residents whose employers use Anthem for their provider network.

“We hate to see that many people have to face the decision of traveling or paying more out-of-pocket for physician services because their insurance does not recognize the local physicians,” White said. “There are 16 medical office practices operated by the hospital that have been impacted by the lack of a preferred pricing arrangement for Anthem. The hospital also provides hospital-based physicians like anesthesiologists, hospitalists and oncologists whose services also are currently viewed by Anthem as being outside their network of preferred providers.”

Asked whether it has been harder to negotiate with Anthem because KCH is a small hospital, White replied in the negative.

“It may seem surprising to some, but that has not been our general experience overall,” he said. “Cigna, United HealthCare, Medical Mutual and Aetna have demonstrated appreciation and understanding of our mission to provide quality, cost-effective care close to home. They understand that a hospital like Knox Community, serving health needs in a local setting, is what their enrollees want and that the total cost of care (hospital and medical office care taken together) is lower here.

“The agreements we have reached with these big insurance companies demonstrate their willingness to partner and collaborate with us in that mission.”

Requests for reimbursement information for comparison purposes from Ohio Health, Licking Memorial Health systems and MedCentral Health Systems were not returned as of press time.

Contact Pamela Schehl

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