Anthem & Mercy Go Their Separate Ways.....

[KellyAH]

Update, Anthem and Mercy are OK through December. Question still stands.

Hello, this is my first post, so be kind. LOL
I'm a Medicare/Marketplace broker in Missouri (St. Louis and surrounding areas) and we have A LOT going on heading into AEP/OEP.
1. Wellcare is on the skids here and Centene will not be able to sell any more plans here until they fix their ratio after 3 years of it being broken. (this is not that much of an issue as I had not planned on selling Wellcare anyway, brokers unite!)
2. Anthem and Mercy (a group of doctors, hospitals, facilities, etc.) have failed to come to an agreement and as of October 1, 2024, that network will no longer accept Anthem plans of any sort, including Supplements.

This is the first time in 10 years of this that I can no longer say if a doctor, hospital, etc. takes Medicare, they take your supplement. Is that as strange and paradoxical as it seems, or am I just sheltered in the land of happy Medicare and it just hasn't come up?

So I'm getting calls from my clients on Anthem plans and one question that came up is household discounts. I have a couple, both on Anthem Plan F, one uses the Mercy network, the other does not. So by switching the husband to UHC, they both lose their household discounts, right? Or does that open an SEP for the wife as well? This is kind of a bummer with people who like/need that discount but one of them has to switch also or he will lose his doctors.

Any thoughts or ideas you have on the 2nd topic would be most welcome. Every time I think about it, I come up with more and more questions! It just seems so strange!

Thank you for whatever input you share!

 

[straightnochaser]

Including supplements? There is no relationship between the provider and the supplement carrier... Beneficiary just tells mercy they have OGM

 

[hockeyday]

Hello, this is my first post, so be kind. LOL
I'm a Medicare/Marketplace broker in Missouri (St. Louis and surrounding areas) and we have A LOT going on heading into AEP/OEP.
1. Wellcare is on the skids here and Centene will not be able to sell any more plans here until they fix their ratio after 3 years of it being broken. (this is not that much of an issue as I had not planned on selling Wellcare anyway, brokers unite!)
2. Anthem and Mercy (a group of doctors, hospitals, facilities, etc.) have failed to come to an agreement and as of October 1, 2024, that network will no longer accept Anthem plans of any sort, including Supplements.

This is the first time in 10 years of this that I can no longer say if a doctor, hospital, etc. takes Medicare, they take your supplement. Is that as strange and paradoxical as it seems, or am I just sheltered in the land of happy Medicare and it just hasn't come up?

So I'm getting calls from my clients on Anthem plans and one question that came up is household discounts. I have a couple, both on Anthem Plan F, one uses the Mercy network, the other does not. So by switching the husband to UHC, they both lose their household discounts, right? Or does that open an SEP for the wife as well? This is kind of a bummer with people who like/need that discount but one of them has to switch also or he will lose his doctors.

Any thoughts or ideas you have on the 2nd topic would be most welcome. Every time I think about it, I come up with more and more questions! It just seems so strange!

Thank you for whatever input you share!

What are you asking? If you have a Med sup it does not matter what the name on the card says, . Tell them to just show their red white and blue card

 

[rmhaire]

Update, Anthem and Mercy are OK through December. Question still stands.

Hello, this is my first post, so be kind. LOL
I'm a Medicare/Marketplace broker in Missouri (St. Louis and surrounding areas) and we have A LOT going on heading into AEP/OEP.
1. Wellcare is on the skids here and Centene will not be able to sell any more plans here until they fix their ratio after 3 years of it being broken. (this is not that much of an issue as I had not planned on selling Wellcare anyway, brokers unite!)
2. Anthem and Mercy (a group of doctors, hospitals, facilities, etc.) have failed to come to an agreement and as of October 1, 2024, that network will no longer accept Anthem plans of any sort, including Supplements.

This is the first time in 10 years of this that I can no longer say if a doctor, hospital, etc. takes Medicare, they take your supplement. Is that as strange and paradoxical as it seems, or am I just sheltered in the land of happy Medicare and it just hasn't come up?

So I'm getting calls from my clients on Anthem plans and one question that came up is household discounts. I have a couple, both on Anthem Plan F, one uses the Mercy network, the other does not. So by switching the husband to UHC, they both lose their household discounts, right? Or does that open an SEP for the wife as well? This is kind of a bummer with people who like/need that discount but one of them has to switch also or he will lose his doctors.

Any thoughts or ideas you have on the 2nd topic would be most welcome. Every time I think about it, I come up with more and more questions! It just seems so strange!

Thank you for whatever input you share!

First. Welcome to the nuthouse.

And second. @hockeyday nailed it. OM doesn't do networks. And most providers don't ask anymore about a supplement. Everything is automated. It'll show up.

And since you're in SL, I hope you're a Cardinals fan.

 

[LostDollar]

Caveat, Medicare Beneficiary only, not an agent.

My providers all require me to give them my Medigap card along with my Medicare card.

I have had no problems with them waiting until after claims processing by both entities to bill me, but they do require both cards when I set up my patient accounts. Heart doc actually requires new copies of both cards on first visit of each calendar year.

Perhaps I could argue my way out of providing the Medigap card but it would be a level of emotional and physical stress neither I nor the practice clerk needs. We both have a much nicer day when I just give them the cards and we both carry on with our days.

 

[straightnochaser]

Caveat, Medicare Beneficiary only, not an agent.

My providers all require me to give them my Medigap card along with my Medicare card.

I have had no problems with them waiting until after claims processing by both entities to bill me, but they do require both cards when I set up my patient accounts. Heart doc actually requires new copies of both cards on first visit of each calendar year.

Perhaps I could argue my way out of providing the Medigap card but it would be a level of emotional and physical stress neither I nor the practice clerk needs. We both have a much nicer day when I just give them the cards and we both carry on with our days.

Having both cards on file is one thing but saying they don’t accept Anthem Supplements is completely different. No one “accepts” anthem supplements.

 

[somarco]

that network will no longer accept Anthem plans of any sort, including Supplements.

Make sure they tell that to CMS . . .

I can no longer say if a doctor, hospital, etc. takes Medicare, they take your supplement

You can say anything you want . . . doesn't make it so.

Does your provider accept Medicare as full payment?

You can get the lowest cost if your doctor accepts the Medicare-approved amount as full payment for a covered service. This is called “accepting assignment.”

www.medicare.gov

 

[KellyAH]

First. Welcome to the nuthouse.

And second. @hockeyday nailed it. OM doesn't do networks. And most providers don't ask anymore about a supplement. Everything is automated. It'll show up.

And since you're in SL, I hope you're a Cardinals fan.

Of course I'm a Cardinals fan!! Blues and Stl SC also! We like our sports here, there's only one we don't talk about. LOL

 

[KellyAH]

Having both cards on file is one thing but saying they don’t accept Anthem Supplements is completely different. No one “accepts” anthem supplements.

Right? I was very confused by this answer when I asked my Anthem producer manager. That goes against all Supplement rules. It's just....wrong....

 

[LostDollar]

(Not an agent)

If active competitors in a specific city market discuss issues like this, you could try talking with kstein and see how his agency is handling this issue.