Note: the following information applies to Anthem Blue Cross Blue Shield patients receiving care in Missouri only.
As of right now, Mercy will not be in network with Anthem on January 1, 2025. While contract negotiations continue, we want to keep caring for you and help you better understand your options. You can still see your Mercy providers as usual until the end of this year.
For decades, Mercy has delivered high-quality care at the lowest average cost for our patients. We are committed to continuing that legacy and feel strongly that our partners must be equally as committed to that vision to continue bringing the best health care experience to the people we serve.
Unfortunately, Anthem has engaged in practices that are below the acceptable patient experience standard. Anthem has routinely prevented us from giving our patients necessary care and denied coverage for care already given. This is occurring at a higher rate than in years prior.
Seeing patients, including many of our own co-workers, increasingly frustrated by Anthem’s policies, we knew we needed to push for changes. As an organization, we've already moved our Mercy co-worker health plan for 2025 to another plan administrator. We're currently negotiating with Anthem toward an agreement that will appropriately value the care we deliver to patients, employers and even Anthem itself. We hope these efforts push Anthem toward improving patient experiences, while also reimbursing our care at fair market rates.
For now, nothing changes. You should continue to visit Mercy hospitals, facilities and physicians as you normally would. We are working diligently and in good faith to reach a new agreement before our current contracts expire.
To ensure the well-being of our communities, and that our patients have access to the care they need, Anthem needs to do what’s right by providing adequate reimbursement rates and reducing administrative burdens, such as wrongful denials and unnecessary delays in patient care.
We’ve built this site to help you find answers to your questions about our negotiations with Anthem. This website will be updated as our negotiations continue, so please check back for the most up-to-date information.
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FAQs
What caused this to happen?
Anthem is attempting to negotiate a new contract that doesn’t provide members with the highest quality care at the lowest cost. We're challenging Anthem Blue Cross Blue Shield (BCBS) in Missouri, and other insurers across the country, to drive change in how we collectively care for our patients.
Why does it matter?
Mercy cares for patients differently. For decades, we've invested in delivering high-quality care, making sure we treat the whole patient effectively while ensuring costs remain low. We need to work with insurers who provide appropriate coverage and make it easy for our patients to receive care. We’re asking all insurers to imagine a brighter future in health care by collaborating with us.
What makes Mercy affordable and high-quality?
Mercy is committed to a model that provides affordable, high-quality care for all. We're doing this today by working with partners, employers and patients throughout Missouri. Seven out of 12 Mercy Hospitals have earned above four stars through CMS and “A” grades through Leapfrog.
How does this impact me?
For now, nothing changes. Patients should continue to visit Mercy hospitals, facilities and physicians as usual. If we don’t reach a new fair agreement, all Anthem commercial, Individual Family Plan and Medicare Advantage, and Medicaid Healthy Blue products will be considered out of network beginning January 1, 2025. As our negotiations continue, you may consider other plans, during this open enrollment season, that offer you in-network access to Mercy.
For more information, choose which coverage plan applies to you below.
What can I do to ensure I keep in-network access to Mercy?
As our negotiations continue, you may consider other plans, during this open enrollment season, that offer you in-network access to Mercy. You can also take these steps to protect your access to in-network care:
- Call Anthem. Using the number on the back of your insurance card, let Anthem know how vital it is to have in-network access to Mercy.
- Contact your broker. If you have a Medicare Advantage or Exchange plan, you may have chosen the plan through a broker. Ask your broker about coverage options that allow you to maintain in-network access to Mercy and its network of health care providers.
- Speak with your HR or benefits manager at work. If you have coverage through your employer, ask your Human Resources or benefits manager about alternative or secondary coverage options that ensure your in-network access to Mercy facilities and providers.
- As a Mercy co-worker covered under the Mercy Health Plan, your current benefits will remain active through the end of the year. On January 1, 2025, your coverage will switch to UMR, a subsidiary and third-party administrator for United Healthcare. There's nothing you need to do to ensure uninterrupted coverage.
- If you're currently covered under your spouse’s Anthem coverage and wish to continue receiving care from a Mercy provider, you can elect Mercy’s 2025 coverage or choose a provider with Mercy in their network.
- As a Missouri Managed Care member, you may choose the MO HealthNet Managed Care health plan of your choice. Each Managed Care health plan has a network of doctors, hospitals and other providers across the state of Missouri. Missouri Managed Care Plans are listed here. Missouri Mercy hospitals and physicians participate in each of these plans.
- When Mercy’s contract with Anthem (Healthy Blue) terminates at the end of the calendar year, Mercy and its physicians will no longer be in the Healthy Blue network. During open enrollment, November 1- December 15, 2024, patients may choose a Missouri Managed Care Plan in which Mercy participates. If you are pregnant or have chronic or acute medical conditions, Mercy will remain available to you during a transition period to ensure the continuity of your care. Patients should contact Anthem (Healthy Blue) by calling the number on the back of their insurance card with specific questions.
- Emergency care will always be available at Mercy, regardless of your health plan coverage.
For more information on Medicaid coverage options, please see here.
Missouri residents with Missouri-based employer:
- Mercy is working directly with Missouri employers to explore options for employees to continue seeing Mercy providers.
- If you have a spouse/qualifying adult on a non-Anthem insurance plan and wish to keep your Mercy providers, consider switching to their plan.
- Consider an exchange/insurance marketplace, like healthcare.gov, to choose a new plan. Mercy can connect you with an expert to help you pick your best option.
Anthem BCBS Members with employers outside of Missouri receiving care in Missouri:
- As you receive care in Missouri, all services will be considered out of network as of January 1, 2025. Mercy is working to define additional options if we are unable to close negotiations before January 1. This applies to the Federal Employee Benefit Program and any BCBS program using a name other than Anthem.
Anthem BCBS Missouri Members receiving care at Mercy in Arkansas, Kansas or Oklahoma:
- All services will remain in network when received in the surrounding states.
There are many Affordable Care options to choose from that provide access to Mercy doctors. To understand your options, visit healthcare.gov or our Health Insurance Marketplace webpage.
As a national leader in value, Mercy is working with Missouri employers, brokers and agents to identify more options to ensure your employees and customers receive uninterrupted, high-quality and low-cost care from Mercy providers. Mercy’s direct contracting solution ensures better care management, streamlined processes and reduced administrative burdens for employers and their employees. Email us at [email protected] for more information.
Employer Options for Ensuring Continued Access to Mercy:
Maintain Anthem as Administrator While Directly Contracting with Mercy
- Ensure continued, uninterrupted access to Mercy’s comprehensive healthcare services for your employees, with no additional cost to your organization.
- Mercy’s dedicated team is prepared to work directly with your HR leadership and broker(s) to facilitate a seamless contracting process.
- Mercy will price Mercy claims for your members and route those repriced claims to Anthem for processing and payment. Anthem will need to agree to receive claims from Mercy.
- This approach introduces minimal disruption to your existing model, ensuring operational continuity and employee satisfaction.
Maintain the Anthem Network Utilizing a Non-Anthem Plan Administrator While Directly Contracting with Mercy
- Ensure continued, uninterrupted access to Mercy’s comprehensive healthcare services for your employees, with no additional cost to your organization.
- Mercy’s dedicated team is prepared to work directly with your HR leadership and broker(s) to facilitate a seamless contracting process.
- Mercy will price Mercy claims for your members and route repriced claims to your Non-Anthem Plan Administrator for processing and payment. Administrator must agree to receive claims from Mercy.
- This approach introduces minimal disruption to your existing healthcare model, ensuring operational continuity and employee satisfaction.
Switch to an Alternative Network for Self-Insured Groups
- Explore alternate health network options where Mercy remains in-network, providing continuous access to the care your employees rely on.
- Alternative options include working directly with Mercy as the network and administrator, Centivo a new health plan option, United, Aetna, Cigna, etc.
Switch to Another Insurance Carrier (e.g., UnitedHealthcare, Cigna, Aetna)
- Explore alternate health insurance carriers where Mercy remains in-network, providing continuous access to the care your employees rely on.
- Many of these carriers are offering competitive bids through brokers, providing potential cost savings while maintaining high standards of care.
Remain with an Anthem-Only Network
- In the event we do not reach an agreement with Anthem before January 1, 2025, Mercy will be out of network for all Anthem members, including your employees. Members may continue to seek care with Mercy using out-of-network benefits, however they may pay more out of pocket.
- For in-network coverage, Anthem members will be required see other providers and healthcare facilities outside of Mercy.
- Some patients will qualify for the Continuity of Care process based on their specific care plan.
For more information about why employers and brokers choose Mercy, please see here.
There are numerous MA options for you to choose from in Missouri. For more information, visit this page.
With Mercy as your health care partner, you have access to:
- 511 primary care providers across Missouri communities
- Specialty care close to home when you need it
- More 24/7 care options, including Mercy Express Care, Mercy on Call and virtual visits
- The MyMercy+ app, allowing you to conveniently message your doctor, refill prescriptions, schedule appointments, view test results and more
- Your electronic health record (EHR), connecting you to your doctor and entire Mercy care team, including specialists, urgent care and ER services
Your benefits won't be impacted. Your care will continue to be covered at Mercy. This is true whether you have Anthem or not. This is also true if you have a supplemental Anthem “Medigap” policy. For more information, visit this page.
I'm a retired federal employee with traditional Medicare (Part A and B) as my primary coverage and Federal Employee Program (FEP) BC/BS as my secondary coverage. If an agreement isn't reached, will Mercy continue to accept my BC/BS after January 1, 2025?
Mercy will continue to serve as a provider for traditional Medicare services. If Mercy goes out of network with Anthem, FEP BC/BS does have a standard option plan with no network requirements, which will allow you to keep your Mercy provider.
Mercy is a network provider for many Federal Employee Health Benefits (FEHB) Medicare Advantage plans (also known as "Retiree Advantage" plans) which don't require any coordination of primary and secondary coverages. If you have questions, please reach out to your OPM contact about your 2025 plan options.
I'm currently on original Medicare and Anthem supplement and am about to begin specialist treatment. I don't want to lose my coverage if I'm still undergoing treatment at the beginning of next year. What should I do?
It's important to follow the advice of your Mercy caregiver and start treatment as soon as possible. Your supplement plan should not be affected. Supplemental plans are in addition to original Medicare. We accept original Medicare. In addition, we are in network providers for many Medicare Advantage plans. Please confirm this with your broker or on Medicare.gov to see what your plan offerings may be for 2025. Please check out Mercy Medicare resources for more information.
What happens next?
Mercy will remain in network for all medical services with Anthem through the end of the year. Unless a new agreement is reached, we'll move out of network with Anthem on January 1, 2025.
Mercy remains open and committed to resolving this issue before the end of the year. We hope you stand with us in encouraging Anthem to engage with Mercy again to keep health care accessible, innovative and affordable to all for years to come.
FAQs about continuity of care
What is continuity of care?
For patients with specific medical conditions and an active care plan that may go out of network on January 1, 2025, continuity of care will extend medical coverage for those who qualify.
How do I qualify for continuity of care?
Anthem will approve continuity of care based on the qualifications you and your care team provide.
How long will continuity of care last?
Continuity of care can vary. If approved, extended coverage can last through the end of your active care plan or up to 90 days following January 1, 2025.
How can I apply for continuity of care?
If you wish to apply, work with your Mercy provider to complete this form and submit it to Anthem as soon as possible.
How can I schedule care today?
We encourage you to schedule your care and procedures with us as usual.
How do I know if I qualify for continuity of care?
Traditional Medicare patients are guaranteed continued coverage at Mercy and won't be impacted by ongoing Anthem negotiations. This includes those with supplemental Anthem "Medigap" policies.
If you have an extenuating circumstance or are concerned about your coverage in the new year for any reason, reach out to Anthem now to see if you qualify. For example:
- Pregnant patients who will be in their second or third trimester on January 1, 2025, may be covered through their postpartum period (even if that period lasts longer than 90 days)
- Pregnant patients with an active care plan who will be in their first trimester on January 1, 2025, may also be covered in certain scenarios, such as a high-risk pregnancy
- Patients receiving active treatment for a serious medical condition, such as a long-term or sudden illness requiring specialized treatment
- Patients scheduled to undergo non-elective surgery, including post-operative care
- Terminally ill patients with a life expectancy of six months receiving active treatment
- Patients in need of continued care deemed medically necessary in accordance with the dictates of medical prudence, such as disability or life-threatening illness
- Hospitalized patients receiving long-term institutional care, such as in nursing homes or hospital wards
"In this time of unknowns, our patients are universally expressing support for Mercy and wanting to continue with their Mercy physicians and the entire Mercy care team."
Peter Danis, MD
Mercy Family Medicine Physician
Read Dr. Danis' full letter in the Mercy Newsroom here.
