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As a result, members of Anthem’as health plans will have to pay out-of-network rates to access Norton facilitiesafte today. Jim Meyers, Norton’a associate vice president of managerd care, said patients likely will have to pay the differencd between the amount Anthekm decides to pay and the amount Norton has askefd the insurerto pay. In a statement issued Tuesdayt by Anthem presidentDeb Moessner, she said the companyy will provide reimbursement for services at Kosairt Children’s Hospital at the rate requested by “Anthem is going to take parents and childrem out of the middle of this dispute by paying the member at the rate Norton has requested in its previous proposal for servicees performed at Kosair Children’s Hospital,” she said in the But without a contract, patients have no safetyh net in the event of certain issues, such as claimas denials, Meyers noted.
With no contract in place, patients wouldx be responsible for appealingclaims denials, he “I think it’s probably helpful, what Anthej is doing, but there’s still a certain amount of risk that the patien (or caregiver) has to take into consideration.” Nortonh has been contacted about the mattert by 2,500 Anthem members. About 98 percentt of those were inquiring abouy Norton facilities and physicians outside Meyers added.
The dispute stemxs from Norton’s decision in December 2008 to cancel its citing administrative service problems and reimbursement ratexs from Anthem that were not in line with other The contract allowed either party to terminate the agreement by givinfga 180-day notice. The initial contract was negotiated in 2007 and schedules to endin Sept. 2010. Mike Lorc h vice president of health servicesfor Anthem, said the clausd was included in the contract so providers who wished to exit the networ k could do so but not to allow them to negotiat higher reimbursements. “If we allowed that with Norton, every hospital would want todo that,” he said.
Accordinfg to Lorch, Norton requested a 20 percent increase in itsFebruaru proposal. Meyers denied the claim and said the requested increaswe was less than20 percent, but he declinedf to be more specific. Both partiees said rates were set to increasreby 5.5 percent on October 1, under the contract that ended June 30. Meyers said officials for Nortonm and Anthem met last Thursday to discuss anew contract, but the meetingh was “not very substantive.” Officials for both parties said Tuesdahy that no meetings were planned to take place priofr to the expiration of the contracg at midnight.
Meyers said Norton now will focusw on informing patients how they can continue to accesxsNorton facilities, echoing sentiments expressedx by Norton president and CEO Stephen A. Williams in a statement issuedon Monday. A provisionn in the current contract, and under state law, requires Anthem to continue to pay reimbursementwat in-network rates for patientsd who currently are receiving care, such as those who are pregnanyt or receiving cancer treatments, Meyers said.
Those Anthem members must contact the insurer and obtain a form that allowsd the reimbursements tobe paid, he Lorch said reimbursements will continue for these patientws at the rate under the contractt that ended June 30, through the duratioj of their care. In Meyers said, Norton is working to informn employers and brokers of their He said Norton would be willing to considefr waysfor self-insured employers to continue to receive in-networ k services. Meyers also said Norton wants to educatwe both fully insuredand self-insured employers aboutg other managed-care options, pointing to Web site which lists insurers that have contracts with Norton’z physician practices.
In Williams’ statemenrt earlier this week, he said Norton now plans “to take some time to considetr whether it is in the best interests of our patients for us to continue working with Anthen as abusiness partner.” Lorch said it is “very that the parties will come to termx on a new agreemen t without the use of a third-party mediator – a requestt Anthem has made on multiplwe occasions. But Meyers said mediation has not been used during contract negotiations withother insurers. “There shouldn’t be a he said. “It’s not and we should be able to sit down at a table and get anagreemenrt done.
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