After more than eight months of negotiations, Anthem has removed MU Health Care’s providers and facilities from its commercial and Medicare Advantage networks, effective Tuesday, April 1, 2025. This means MU Health Care is no longer in network with Anthem, Blue Cross Blue Shield and HealthLink commercial plans patients get through employers or the ACA marketplace, or Anthem Blue Cross Blue Shield Medicare Advantage HMO and PPO plans. This network change does not impact patients with Healthy Blue Medicaid or University of Missouri Student Advantage plans, Mizzou Pharmacy or medically necessary emergency care.

We are seeking parity. MU Health Care is receiving rates 30% less than our peer academic health systems like the University of Kansas Health System and University of Kentucky HealthCare. Parity also involves Anthem being more in line with the rates that MU Health Care currently is paid by other commercial payers that have recognized the value of the services MU Health Care provides, and in turn, agreed to much more competitive rates in line with that of similar academic health systems.

We are requesting rates that cover the cost of inflation. Over the last three years, MU Health Care has experienced an average increase in expenses of 7.3% per year, while the average reimbursement rate only increased 3.1% per year.

We are asking for fair business practices. Anthem has in excess of $20 million in claims that are 90 days overdue. MU Health Care has 30 full-time staff assigned to manage the administrative burden placed on us by Anthem's business practices.

We can't determine what will happen to employer and policyholder costs. However, Anthem Blue Cross Blue Shield is owned by Elevance Health, a publicly traded, for-profit corporation. As one of the largest for-profit insurance companies in the country, Elevance had $5.980 billion in net income for the twelve months ending December 31, 2024. From 2018 to 2023, Elevance experienced a 60% increase (average of 12% per year) in net income, from $3.750 billion to $5.987 billion, respectively. In their 2023 earnings report, Elevance indicates the strong performance of its Health Benefits segment was primarily driven by higher premium revenue in its Commercial Health Benefits business.

According to the MO Department of Commerce and Insurance's 2023 Health Insurance Market Report, Anthem and its peers increased annual premiums to employer groups by as much as 37% over the last decade, but did not pass on those rate increases to health care providers.

MU Health Care has been open to meaningful negotiations for the past eight months and continues to remain open. We have made significant reductions in our ask since our initial proposal on July 26, 2024, to expedite negotiations in the best interest of our patients.

Unfortunately, Anthem has repeatedly come back with the same 1-2% annual increases in their offers, which does not approach actual increases in our cost of providing services or to address the significant parity gap that exists with other academic health systems and commercial payors.

This is a truly unfortunate situation. And although we are thankful local hospitals are able to care for some patients in need, the reality is there are unique services MU Health Care offers as an academic health system that many of these other hospitals don't, including services at our Children's Hospital, Maternal Fetal Care Center, Blood and Marrow and Cellular Transplant Therapy Program and so much more. We also receive thousands of transfers every year from other hospitals in our service area because we are the only system with the specialists and technology needed.

Yes. This change does not affect coverage for emergency services. Regardless of insurance status, you will not be responsible for more than the in-network out-of-pocket cost for emergency care in any of our Emergency Departments. If your plan includes benefits for emergency services, then Anthem is legally required to cover those services at the in-network rate.

Yes, but Anthem may require you to pay higher out-of-pocket costs or use out-of-network benefits if available. Contact Anthem to verify your coverage options.

If you are receiving treatment for certain ongoing medical conditions, you may be eligible for a Continuity of Care benefit. Call Anthem at the number on the back of your insurance card to determine if you are eligible. While Anthem makes the final determination about eligibility, we have additional information available for you.

To protect your ability to continue receiving care from MU Health Care on an in-network basis:

• If you receive your Anthem insurance through your employer, tell your Human Resources or Benefits Department that you want to keep access to MU Health Care’s physicians, advanced practice providers and services.
• Call Anthem at the number on the back of your insurance card and let them know you want to keep access to the MU Health Care physicians and advanced practice providers and services you trust.
• View the list of insurance companies with which MU Health Care contracts.
• Learn more about Continuity of Care. Anthem ultimately will determine if you qualify, but we have posted more information on our website, along with helpful instructions developed by our medical staff to make the process as easy as possible.