Aspirus, Anthem Blue Cross & Blue Shield reach agreement

(WSAW)
Published: Nov. 23, 2022 at 9:53 AM CST
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WAUSAU, Wis. (WSAW) - Aspirus Network Inc. and Anthem Blue Cross and Blue Shield in Wisconsin on Wednesday announced a new agreement that ensures continued in-network access to care for all of Anthem’s members at Aspirus Network providers and facilities.

Matt Heywood, President, and CEO of Aspirus Health said the agreement will help advance the system’s mission of healing people, promoting health, and strengthening communities.

“Our primary focus is always on those we serve,” Heywood said. “I’m pleased we were able to reach an agreement for our patients.”

“Anthem is committed to providing access to high-quality, outcomes driven health care. Our work at Anthem also focuses on affordability and this new agreement helps us achieve that goal,” said Paul Nobile, President of Anthem Blue Cross and Blue Shield. “We’re pleased to have worked in good faith with Aspirus to ensure those covered by individual and employer-based plans, as well as those we serve in Medicaid and Medicare, can continue to access the care they need.”

Numerous people in central Wisconsin expressed concerns to 7 Investigates after receiving letters from Aspirus and Anthem that they ended their rolling agreement for 2023. Over the last several weeks, the two entities have been in negotiations to come to terms they both can agree on.

Aspirus is one of the two largest sets of providers in the north central region of the state. Anthem told 7 Investigates it has 1.3 million medical members around Wisconsin. It also is one of the coverage options for federal employees, like postal workers.

Several people expressed to 7 Investigates their gratitude and relief as they weighed their options on whether to switch providers or insurance companies.

“Just a little more relief off of my shoulders,” Tim Dean, an Aspirus patient, and Anthem member shared.

Retired, over the last month he had spent about an hour or so a day making calls or doing research to determine whether to take a chance to keep his coverage and risk losing his doctor or switch to a plan he believed did not work as well for him.

“I was worried about that because I do have an appointment coming up in December... and if they wouldn’t have come to an agreement that would have messed it all up because if I would have went back to him after the first of the year, that’s out of network; that’s more money out of my pocket.”

After checking other options, he decided to stick to his union roots and trust that they would reach a deal.

“Feels good; a lot less I have to worry about.”

7 Investigates

Others in limbo made a different decision, especially those looking for a Medicare Advantage Plan. Until this announcement, Security Health Plan was the only insurer that offered a Medicare Advantage Plan that had both Aspirus and Marshfield Clinic providers in-network.

“Even though we are part of the Marshfield Clinic Health System, we are our own insurance company, and we do partner with other providers outside of Marshfield Clinic, Aspirus being one of those,” Jennifer Sherman, Security Health Plan’s chief growth officer explained. “Aspirus has been a longtime partner of ours, a very valuable partner that, you know, we’re happy to continue that success forward with.”

The company has a contract with Aspirus for the next couple of years. When asked whether the company believes it needs to contract with Aspirus in the market where Aspirus and Marshfield Clinic are, largely, the only options for patient care, she responded:

“We certainly want to, right? I don’t think that we want to limit folks’ choices in their provider. You know, who you choose to doctor with is a very important decision, so we certainly want to bring the most flexibility and options for members as possible. So yes, we certainly would want to, and in any circumstance that we can.”

How Security Health Plan designs its plans and what is covered, Sherman stated, is based on customer feedback. Whether it is more people calling in asking about a particular procedure, or employers asking for lower premiums. She said in negotiations with any provider, it is about balancing competing needs between the insurer, the providers, and the patients.

“It’s more of an art than a science,” she said. “It’s trying to take all of the factors in, you know, the cost of health care continues to rise. So, we are constantly looking for ways to reduce the cost of health care and keep it affordable for members, as well as keep it sustainable for providers.”