Patients in limbo as Ohio State, Anthem negotiate insurance rates

COLUMBUS, Ohio (WCMH) -- Contract talks between The Ohio State University Wexner Medical Center and Anthem Blue Cross Blue Shield are ongoing, but if no agreement is reached by Dec. 31, Anthem patients at OSU would lose their in-network coverage.  

There are more than 1350,000 Anthem patients receiving care from Ohio State and they could all end up paying much more out of pocket starting Jan. 1.  

Ohio State patients Ryan McManus and Hoa Pyles McManus said they were just told they may lose in-network coverage.  

“We were notified on Dec. 4 via an email and Ohio State notified patients that there might not be coverage on Jan. 1,” Ryan McManus said. “We were given 27 days to find new coverage.” 

The McManus’ said they have been Anthem customers for six years and they have been happy with their coverage. Hoa McManus was diagnosed with breast cancer in July 2022 and said Anthem covered most of her treatment at The James Cancer Hospital. She has been in remission for almost two years, but she still has many appointments to keep up with at The James and OSU. Now the couple is concerned about insurance coverage.  

“I have multiple doctors’ appointments to go to make sure I’m still in remission, so does that mean I go to them regardless?” Hoa McManus said. “Because I’m not going to seek care anywhere else. This is one of the best cancer hospitals in the country.” 

An Anthem spokesperson said OSU wants to increase prices at three times the inflation rate; an Ohio State spokesperson said the insurance company has underpaid for years and they are asking Anthem for appropriate rate increases.  

Both sides said they are doing everything possible to reach an agreement, but the McManus family and thousands of other patients are left to figure out what to do before the new year.  

“We’re not really thinking about the cost of it, we’re thinking about Hoa’s wellbeing and ensuring that she has continuity of care,” Ryan McManus said. “Switching from The James is not an option so we need to figure out how we can have coverage to continue the care that she has.” 

The couple said they were given a few options. They can try to get Continuity of Care benefits, which allows patients with certain health conditions to continue receiving care after the deadline at an in-network rate. They can also go to the marketplace and find new insurance. Their last option is to ask Anthem to buy out-of-network coverage which would increase the McManus’ insurance rates.  

Both Hoa and Ryan said they are frustrated and just want answers from Ohio State and Anthem.

“For Anthem executives, we need you to work with us to ensure continuity of care for patients that still need it, and at Ohio State we need confirmation that patients can continue to come even after the Anthem coverage is going away.” Ryan McManus said. 

“These are real people and real people’s lives and I know everyone says that and It’s so cliche, but you know, it’s true, it’s absolutely true,” Hoa McManus said.  

Anthem and OSU have until Dec. 31 to come up with a new contract that both sides agree to, and there is still a chance an agreement can be reached. In the meantime, both sides said they are ready to help patients and customers answer any questions.  

For more information from Anthem Blue Cross and Blue Shield, click here. For more information from Ohio State, click here.   

Read the full statements sent to NBC4 from both OSU and Anthem below. 

Ohio State University Wexner Medical Center 

“Ensuring our patients have access to the most advanced, life-saving care in central Ohio is our major priority. We continue to strongly advocate for our patients as we actively negotiate with Anthem for new, fair contracts before the existing ones expire on Dec. 31. 

We want to remain in network with Anthem so that every patient covered by the insurance company’s policies has access to our advanced care for treating cancer, heart disease, brain disorders and many other life-threatening conditions. 

We’re the region’s only nationally ranked academic medical center and NCI-designated comprehensive cancer center and we serve over 1.4 million patients across all 88 counties in Ohio. Often, we are the only provider in Ohio for specialized, life-saving treatments, and that is why it is essential that Anthem continue to keep the Ohio State Wexner Medical Center and The James Cancer Hospital in network for all of the patients we serve. 

We have been working in good faith with Anthem for more than a year to reach new contracts that would preserve health care access for more than 135,000 people in central Ohio. We have tried very hard to avoid negotiating up to the final days of the approaching Dec. 31 contract deadline because of the disruption this causes to patient care and the resulting anxiety it causes for our patients and their families. 

Our patients and their care are top of mind. We will be communicating directly with affected patients about their particular needs and potential solutions available while we work to get new, fair contracts with Anthem. 

Just as inflation has driven up every household’s costs, we have absorbed a 45% increase in our labor, pharmaceutical, supply and other expenses to provide our patients with the care they need over the past five years. 

We are not asking Anthem to make up this gap, just to pay us fairly given these continually rising expenses. In the past two years, we have reached mutually-agreed-to contracts with the other major managed care companies in the market, so we know that our approach and our proposal to Anthem make sense. 

Fair agreements with insurance companies like Anthem are critical to fulfilling our important mission to improve health in Ohio and across the world through innovations and transformations in research, education, patient care and community engagement. 

The citizens of Ohio – our patients – need, expect and deserve the high quality, advanced care we provide.” 

Anthem Blue Cross and Blue Shield 

“We are currently in talks with the OSU health system to extend access to affordable care at OSU beyond December 31 for our members covered through their employers. We are optimistic an agreement will be reached. We are concerned that OSU wants to increase its prices for patients and their employers at rates more than three times higher than inflation. These price hikes would increase healthcare costs for Central Ohio by $185 million over the next three years. Ohio’s consumers and employers who would pay these cost increases cannot afford these extreme price hikes. 

We will continue to work with OSU to reach an agreement that maintains access to affordable care for our members.”