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‘What do we do?’ CommonSpirit hospitals no longer in-network for thousands of Coloradans with Anthem insurance

CommonSpirit Health said in a statement that 40,000 patients with Anthem Blue Cross Blue Shield health insurance are impacted by the lack of an agreement

The sign for CommonSpirit Health's St. Anthony Summit Hospital is pictured just off Colorado Highway 9 near Frisco. CommonSpirit facilities, including this hospital, could be out of network for Anthem Blue Cross Blue Shield patients if the two health care entities don't reach a new agreement by May 1, 2024.
Ryan Spencer/Summit Daily News

Summit County resident Lisa Fine says she loves the primary care doctor and specialists she’s seen at St. Anthony Summit Hospital for years. But barely a month after being diagnosed with osteoporosis, a chronic bone disease, Fine said a dispute between two health care giants is forcing her to look as far away as Denver for new doctors.

“I have to start over with someone new,” Fine said. “When you’re already trying to navigate something that can be a life-changing situation, this just adds another level of stress on it that is unwarranted.”

Fine is among the tens of thousands of Coloradans with Anthem Blue Cross Blue Shield insurance who lost in-network access to CommonSpirit Health hospitals as of Wednesday, May 1. CommonSpirit said in a statement that this impacts more than 40,000 patients in Colorado with Anthem insurance.



Amid a public dispute over reimbursement rates, Anthem and CommonSpirit have been unable to negotiate a new contract. The previous contract between the two expired at the end of April, limiting healthcare options for thousands in Colorado.

With no deal reached, CommonSpirit’s St. Anthony Summit Hospital, Breckenridge Emergency and Urgent Care Center, Copper Emergency and Urgent Care Center and Keystone Emergency and Urgent Care Center, as well as a dozen other facilities statewide, are no longer in-network for Anthem commercial and Medicare Advantage health plans. The Peak One Surgery Center in Frisco has a separate contract with Anthem and reportedly will remain in network for patients with Anthem insurance.

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Anthem and CommonSpirit have both said that contract negotiations are ongoing with the goal of quickly reaching an agreement that will maintain patients’ access to care. But the country’s second-largest health insurance company and third-largest hospital system have also offered dueling claims about what has led to the impasse.

Anthem State Plan President Matt Pickett said Wednesday that CommonSpirit “is already a high cost provider” and that “further cost increases of any sort will dramatically increase costs for our members and their employers.”

“We continue to have negotiations with (CommonSpirit). That has not changed,” Pickett said. “We remain fully committed to reaching a collaborative, multiyear agreement with CommonSpirit that will give Anthem members access to the affordable healthcare they deserve.”

Meanwhile, CommonSpirit Mountain Region Chief Medical Officer Oswaldo Grenardo said that the provider has asked Anthem for a “fair and reasonable rate” that will “support and sustain the services we have in this area.”

“We are your doctors. We are your physicians. We’re your nurses. We live in your communities,” Grenardo said. “That’s why we have built trust and, hopefully, the confidence of our communities that we’re going to be there through thick and thin.”

Advocates at the Colorado Consumer Health Initiative have said that since negotiations like this between healthcare entities happen behind closed doors, it can often be hard for members of the public to parse the claims being made by either side.

Colorado Insurance Commissioner Michael Conway in a news release Wednesday called on Anthem and CommonSpirit to reach a deal that would bring CommonSpirit back in-network for Anthem health plans.

“Unfortunately, Coloradans are the ones caught in the middle when large health systems and large insurers fail to reach an agreement,” Conway said. “As Anthem and CommonSpirit continue to work towards a new agreement, they must be cognizant that increased health care costs are ultimately borne by those same consumers in increased premiums. We have all worked very hard to keep health care costs under control for the benefit of Coloradans — it is important that work continues in these negotiations.”

The Colorado Division of Insurance has a list of frequently asked questions for people impacted by the disruption, the release states. Anthem members should contact their insurance provider through the phone number listed on the back of their ID card.

While contract negotiations continue, the Division of Insurance will reportedly work to ensure that Anthem has an adequate health care provider network. The insurance division will continue to make sure that all Anthem members are able to access the care that they need from in-network providers, and if that access is inadequate, that Anthem will approve those members going out of network at no greater cost than if they went in network, the release states.

Anthem is also providing assistance to ensure continuity of care for members who are pregnant, undergoing a course of treatment for a serious and complex medical condition, undergoing a course of inpatient care, terminally ill, or scheduled to go through nonelective surgery, according to the Colorado Division of Insurance.

As negotiations continue, residents like Fine — who said her recent diagnosis is not serious enough to qualify for continuity of care but is nonetheless “scary” — are left in the lurch, trying to sort out the practical and financial implications this disruption could have on their lives.

“I think they’re all guilty, CommonSpirit and Anthem,” Fine said. “I don’t see any heroes in this game. People like me are left holding the bag and wondering, ‘What do we do?'”

This story is from SummitDaily.com


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