CommonSpirit Health hospitals, providers dropped from Anthem insurance network

DENVER (KDVR) — A nonprofit Catholic health system says its hospitals have been dropped from the Anthem Blue Cross Blue Shield Colorado network after “ongoing, good-faith negotiations,” leaving some communities without an in-network hospital.

The insurance network responded by saying the health system has “chosen” to leave and accused the system of having a “pattern of disrupting care for its patients as a negotiation tactic to demand unreasonable price hikes.

CommonSpirit Health said that its hospitals and providers serve over 40,000 patients and the health system never intended to leave the Blue Cross Blue Shield Colorado network, but only to work toward “a balanced agreement.” Patients can still access care, but if their primary insurance is through Anthem Blue Cross Blue Shield, treatment costs will be entirely out of pocket.

The two companies’ agreement was terminated at midnight on April 30, leaving the health system’s patients without in-network access to those hospitals, clinics or providers.

“CommonSpirit firmly believes that everyone deserves safe, affordable, and high-quality healthcare from their chosen doctors and nurses, which is why we are disappointed that a responsible agreement was not reached. Our aim was to have an agreement that safeguards patient care and protects choice of doctors by keeping CommonSpirit Health services in network for Anthem members,” said Dr. Oswaldo Grenardo, chief medical officer for the Mountain Region of CommonSpirit.

There are 11 CommonSpirit hospitals no longer in the network for Anthem customers, namely:

• Longmont United Hospital
• Mercy Hospital (Durango)
• OrthoColorado Hospital (Lakewood)
• Penrose Hospital (Colorado Springs)
• St. Francis Hospital (Colorado Springs)
• St. Francis-Interquest Hospital (Colorado Springs)
• St. Anthony Hospital (Lakewood)
• St. Anthony North Hospital (Westminster)
• St. Anthony Summit Hospital (Frisco)
• St. Mary-Corwin Hospital (Pueblo)
• St. Thomas More Hospital (Cañon City)

It’s important to note that some of these hospitals have few, if any, local alternatives. In Pueblo, St. Mary-Corwin Hospital is one of two hospitals in the city. In Canon City, St. Thomas More is the only hospital option available, as is St. Anthony Summit in Frisco.

Some other hospitals will also be impacted later this year. According to CommonSpirit, due to separate contracts, St. Elizabeth Hospital in Fort Morgan will remain in Anthem’s network until at least July 11 and Peak One Surgery Center in Frisco will remain in Anthem’s network until at least July 25.

CommonSpirit said that Anthem “has refused to acknowledge soaring inflation and offered reimbursement rates that do not keep up with the cost of care.” The company said it is asking Anthem to “allow patients to maintain access to the doctors they know and trust,” by maintaining an agreement with CommonSpirit.

“Reasonable reimbursements from large insurers like Anthem allow nonprofit hospital systems like CommonSpirit Health to retain healthcare professionals, ensure access to providers and continuity of care, sustain and introduce new services to the community, invest in technologies, and maintain our premier facilities throughout the state,” CommonSpirit wrote.

Anthem disagreed in a statement released to FOX31 on Thursday.

“Anthem has offered CommonSpirit Health a multi-year agreement that includes reasonable reimbursement rates. Unfortunately, CommonSpirit has chosen to leave Anthem’s network in Colorado,” Anthem wrote.

“CommonSpirit has established a pattern of disrupting care for its patients as a negotiation tactic to demand unreasonable price hikes. CommonSpirit recently used this tactic in Arizona, California and Nevada – leaving other health plans’ networks for as long as 45 days. Anthem remains fully committed to reaching a collaborative, multi-year agreement with CommonSpirit will give Anthem members the access to affordable healthcare that they deserve,” Anthem said.

Anthem members with questions can visit anthem.com/CommonSpiritCO or call member services at the phone number on the back of member ID cards.

Patients who are currently in active treatment at a hospital or clinic may qualify for protected in-network access. There is an online form available here for continuity of care requests.

Medicare patients with a secondary coverage plan by Anthem should have benefits verified prior to service. For patients who have Anthem Medicare as their primary insurance, CommonSpirit is now out of network. Patients with traditional Medicare as their primary insurance can see any licensed Medicare provider, including through CommonSpirit.

The health system has launched a website to answer expected questions about this change . Additionally, patients can call 1-877-213-7081 to receive personal assistance.

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