Anthem and Aspirus still in negotiations for 2023, patients weighing options

RUDOLPH, Wis. (WSAW) - Many people in north central Wisconsin are comparing insurance plans with their medical needs, and the providers they have built relationships with over the years. For those currently on or anticipating coverage with Anthem Blue Cross Blue Shield, many are crossing their fingers as the insurance company negotiates with one of the two primary medical providers in the area: Aspirus.

Aspirus has not acknowledged or returned 7 Investigates’ request for updates or comment, but Anthem confirmed it is still trying to work out a deal to be in the Aspirus network for 2023. Aspirus terminated the rolling contract it had with Anthem since 2017 after initial negotiations. Its chief financial officer said they did not believe they would get a fair agreement without terminating the current agreement, and began negotiations again.

Aspirus sent letters to patients in mid-October, informing them that while they were working with Anthem on an agreement for 2023, there was a potential that they would not become part of the network. This month, Anthem sent its own letter, stating the same:

“This letter is being sent to inform you that Aspirus Health Network, Inc. has issued a letter of termination and will no longer serve Anthem’s Medicare Advantage members beginning January 1, 2023. Of course, we will continue to work diligently with Aspirus in the hopes they will see the importance of continuing to serve you as an Anthem Medicare Advantage member.”

This particular letter was sent to Tim Dean in Rudolph, but Anthem told 7 Investigates that negotiations with Aspirus are for all of their plans, not just Medicare Advantage plans. Dean is both an Anthem member and Aspirus patient. He said, “This is the best insurance I’ve had in years.” He also noted he liked his doctors but will not know what quality he will get if he has to switch.

Dean retired at age 62 after working full-time for 40 years. Since he retired early, he went through a series of different plans on the marketplace until he turned 65 and could enroll in Medicare.

“I switched to Blue Cross Blue Shield because it was a better deal, you know, I didn’t have to pay as much out of my pocket and stuff.”

However, before making the switch, he asked Anthem whether he had to find new doctors, because every time he had to switch insurance, that was his experience.

“I called three doctors; ‘no, we’re not accepting any more patients; we’re not accepting any more patients.’ I did find a doctor and he said ‘we’re accepting, but it’s going to be two-three months before we can get you in for an appointment.’ So, at that time I was very frustrated.”

He called the insurance company he had at the time and they were able to set him up with a different doctor that week, but he said the process was such a hassle, not only to secure a doctor and appointment but to transfer paperwork and records over too. For the last three years, Anthem has been able to tell Dean he did not have to switch doctors. These two letters from Aspirus and Anthem have him in a pickle.

“If they don’t reach an agreement, how many people are going to be out there looking for doctors? And there’s only so many doctors available,” he noted. “So, is it going to be fun or easy? No. I’m going to be back to where I was when I switched a couple of years ago. I’ll be back trying to find a doctor that, you know, is available.”

Medicare open enrollment is available through Dec. 7. Dean said he is weighing whether to switch plans or switch doctors again. Being a former union member, he thinks he will likely stay on his insurance plan and cross his fingers that the two organizations will come to an agreement at the eleventh hour, as union contracts often do.

For those who are still working and receive employer-offered benefits, their open enrollment window may have already passed. Some Aspirus patients with Anthem insurance who are in that situation told 7 Investigates they looked at possibly self-insuring but did not find it to be a feasible option and ultimately enrolled with their employer’s coverage.

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