St. Francis, Anthem Feud Continues to Alienate Patients

Every day, many TOA llc employees in the town of Mooresville, Indiana, drive past their local hospital with a difficult thought in mind. If the breakdown in contract talks persists, the only local hospital for several miles will no longer be in their insurance network. TOA is an auto factory parts manufacturer in Mooresville, Indiana, which, like many other Indiana employers, chose a much more versatile Anthem as its insurer. The hospital, run by St. Francis, has ended their rocky relationship with the company's insurance carrier, Anthem after contract negotiations broke down.

The original deadline for service, November 2, 2008, has been extended in the hope of reaching a consensus, but many customers caught in the middle have little confidence in either company's ability to come to an agreement. The new deadline is for Friday, November 7. Citing progress, St. Francis and Anthem show a willingness to return to the negotiation table, but some customers have already changed doctors and hospitals, wondering if they should request their company change insurance carriers altogether.

St. Francis operates 13 very well-known (and sometimes exclusive to the community) hospitals in Indiana and parts of Illinois. Many of the hospitals have been in Indiana for a long time. Anthem is a household name as well, offering several varieties of insurance to employers and individuals. So far, the two companies Anthem and St. Francis, have done little but point accusatory fingers at one another and have not come to much of a conclusion. Most covered employees have been informed by their employers of the conflict. TOA employees attended a meeting earlier this month with the disheartening news.

Employees with scheduled surgeries after the deadline which was originally November 2, pregnant couples who intended to deliver at St. Francis who have Anthem insurance, Anthem patients with a St. Francis family doctor, and individuals who live in the Mooresville area with limited transportation who rely on the local hospital but have Anthem are all stunned and saddened that Anthem and St. Francis could not come to a resolution for the sake of patients and feel the companies should not have put patients in the middle of the disagreement. St. Francis has dedicated a website and a toll-free number for displaced patients, but many are disappointed with the decision to end negotiations.

According to St. Francis, medical emergencies are not subject to the "out of network" increase in expenses but stresses that patients should follow all pre-authorization guidelines set by Anthem. This does not bode well with Anthem's many customers who feel the companies have both left them high and dry with their quibbling.

TOA employees are not the only individuals affected by the Anthem - St. Francis feud. According to the Indianapolis Star, Anthem insures over two million Indiana residents. There are eleven St. Francis hospitals in Indiana, which means thousands of Indiana patients (and hundreds of doctors) will be subject to higher medical costs. (1)

St. Francis states the dispute occurred due to Anthem's constant delay and inaccuracy in paying some claims as well as the desire for an increase in rates. Anthem has told customers that St. Francis has asked for an unreasonable increase in reimbursement rates, which is unacceptable in the current economic climate. Consequently, the doctors and patients have been caught in the crossfire. The relationship between the two companies has not always been so rocky. Just in 2004, Anthem rewarded grants to the Sisters of St. Francis for health centers and clinics. (2)

Whether Anthem is late in processing or St. Francis's demand for a 50% rate increase (3) over 39 months is the unreasonable issue, patients are disappointed. TOA employees, as the company employees of many other factories and businesses across Indiana, are disappointed. "Mooresville Hospital just opened up an emergency wing at the beginning of this month," said one employee. "I can't see anyone being able to afford to go there any more. I have to find a new doctor for my kids and I'm just disgusted. This shouldn't happen to hard-working folks."

(1) St. Francis Threatens Split With Anthem. Daniel Lee. Available Online Indy Star: http://www.indystar.com/apps/pbcs.dll/article?AID=2008810140382 .

(2) Anthem Foundation Awards $685,000 With Focus on Making it Easier for People to Get Healthcare. Deborah New. Available Online Anthem: http://www.anthem.com/wps/portal/ahpfooter?content_path=shared/noapplication/f0/s0/t0/pw_a034086.htm&label=Anthem+Foundation+Awards+$685,000+With+Focus+on+Making+it+Easier+for+People+to+Get+Needed+Health+Care .

(3) Experts: Anthem, Hospital Will Reach Deal. Mark Taylor. Available Online Post Tribune News: http://post-trib.com/news/1221823,anthem.article .

St Francis, Anthem Extend Deadline as Contract Talks Continue. Daniel Lee. Available Online Indy Star News: http://www.indystar.com/apps/pbcs.dll/article?AID=/20081104/BUSINESS/811040345 .