Here are three health system and payers splits since May:
1. Phoenix Children's patients are out of network with Aetna after the sides were unable to reach an agreement by their Aug. 6 deadline.
"We will continue to work diligently with Aetna to reach an agreement that addresses the significant number of routine denials and one that supports the expanded, expert care we provide to children and their families throughout our community," Phoenix Children's said in an Aug. 7 news release.
Aetna said it will continue to negotiate with the hospital but has been "unable to reach a new agreement due to their unreasonable and excessive rate increase demands," according to a statement shared with news station KTVK.
2. In July, a commercial reimbursement fight between Anthem Blue Cross Blue Shield and Cincinnati-based Bon Secours Mercy Health caused nearly 50,000 Medicaid enrollees to lose coverage. An in-network contract between the organizations for Medicaid managed care members was terminated July 1, but beneficiaries had access to Bon Secours Mercy facilities through the end of July.
In addition to Ohio Medicaid members, the Anthem spokesperson told Becker's its Medicaid managed care plan in Virginia will be out of network with BSMH by Sept. 1. For Medicare Advantage, 19,000 Anthem members in Virginia will be out of network with BSMH by Aug. 1, and Anthem MA members in Ohio and Kentucky will be out of network by Oct. 1.
An in-network contract between the organizations for Medicaid managed care members was terminated July 1, but beneficiaries have access to Bon Secours Mercy facilities through the end of July.
3. In May, Gainesville-based Northeast Georgia Health System went out of network with UnitedHealthcare's employer-sponsored and individual plans after the two sides were unable to reach a new contract. The split affected about 12,000 Northeast Georgia Health System patients.