Health insurance contract standoff may impact holders in area

About 3,200 Anthem Blue Cross and Blue Shield of Colorado health insurance holders in Pueblo County could be affected by a contract negotiation stalemate between the insurance company and CommonSpirit Health, the parent company that oversees St. Mary-Corwin Hospital in Pueblo.

The two organizations are pointing fingers at each other for the breakdown in negotiations when an agreement was not reached by May 1.

“This has become a very emotional issue for a lot of people,” Mike Cafasso, chief executive officer of St. Mary-Corwin, told the Chieftain Friday. “Healthcare is very personal when you have trusted in your provider and your hospital and this side of things doesn’t always get played out like they are now.”

CommonSpirit officials said in a statement they proposed a temporary contract extension that would have allowed them to continue to provide in-network services to Anthem members while negotiations continued, “but Anthem denied our request.”

During negotiations, “Anthem has refused to acknowledge soaring inflation and offered reimbursement rates that do not keep up with the cost of care,” the officials said.

On the other side of the matter, Matt Pickett, president of Anthem Blue Cross Blue Shield of Colorado, told the Chieftain that the issue “is about affordable healthcare.”

“CommonSpirit is already one of the higher costing providers in the state and they want to unacceptably increase costs for Colorado consumers and employers,” Pickett said.

“Colorado cannot afford such dramatic cost increases. We offered a multi-year agreement that includes reasonable rate increases, however, if CommonSpirit wants to stay out of our network we have a broad network of alternative care providers.”

As a not-for-profit health system, CommonSpirit said in its statement that the company “reinvests every dollar earned back into the communities it serves.” Cafasso said anything the hospital earns “goes right back into patient care.”

“Eighty percent of our clients self-fund their health care which means employers are paying for the medical costs that their members incur. So any increase is passed down directly to the employers, and as stewards of our clients’ money we just can’t let that happen,” Pickett said.

Impact of stalemate could be felt beyond Pueblo

“I just want to make sure our patients have access to everything they need by the way of doctors and nurses, equipment and facilities. Patients need to have easy and simple access and the best care as close to home as possible,” Cafasso said.

Cafasso said it is not just Pueblo patients who are affected, as many of the patients St. Mary-Corwin serves come from the San Luis Valley, Trinidad, Walsenburg, La Junta, Lamar and Springfield.

“It is enough of a drive for them to come to Pueblo to receive care, but if they were unable to do that they may have to travel further north to Colorado Springs or in some cases to Denver. That creates patient care issues — it is just not workable for a lot of patients,” Cafasso said.

“If you have ongoing treatment and have to be somewhere several days in a row or several weeks in a row, you want care close to home,” Cafasso explained. “That is our continued focus.”

“If a member believes an in-network provider is not within reasonable travel distance they should always contact Anthem. We’ll ensure they get access to the care they need,” Pickett said.

Continuity of Care may be an option

Cafasso said St. Mary-Corwin officials are reaching out to the hospital’s patients proactively, especially those already on the schedule, “to find out if continuity of care may apply for them and to discuss their appointments and what options they have.”

To get ongoing updates, ask questions, or fill out a continuity of care form, St. Mary-Corwin patients with Anthem can go to anthemcommonspirit.com. Patients also can call a toll-free hotline at 877-213-7081.

“If a member has a concern related to their own circumstances, they should reach out to us on the number on the back of their member services ID card for questions they may have,” Pickett said.

UCHealth Parkview can be an option

“The most important thing to Anthem is assuring our members get the care they need when they need it. We do have alternative providers in Pueblo including UCHealth Parkview,” Pickett said.

Local patients may contact a UCHealth phone line to leave a message and request a call back for assistance at 719-542-1868. To find direct contact info for a provider or clinic, patients can also visit parkviewmc.com/doctor/.

“UCHealth is in-network with all Anthem plans, except for the Pathway Essentials plan,” said Carolyn Vogrin, communications and media relations spokesperson for UCHealth.

Negotiations continue; agreement still could happen

“We continue to try to collaborate with CommonSpirit to try to reach a new agreement,” Pickett said. “I am optimistic that we can.”

“I am on the ground here, the front lines, and we are having to deal with the delays and I am hoping it is just a delay,” Cafasso said.

Pickett said he believes CommonSpirit uses disruption of care as “a negotiation tool to demand unreasonable price hikes.”

“They have followed this pattern in other nearby states with other health plans recently — Arizona, Nevada, California,” he said.