Oct. 25--Chesterfield-based Mercy Health has been added to Anthem Blue Cross and Blue Shield in Missouri networks for individual member health plans, Anthem announced Friday.
This includes Mercy Hospital St. Louis, Mercy Hospital Washington, Mercy Hospital Jefferson, Mercy Rehabilitation Hospital, Mercy clinic physicians, Mercy Home Infusion, Mercy Home Health and Mercy Hospice.
Mercy will be on Anthem's Pathway and Pathway X networks, said Deb Wiethop, an Anthem spokeswoman. Pathway is Anthem's network for individuals off the exchange with private plans, and Pathway X is for individual members who shop on the federal health care exchange in Missouri.
She said the agreement with Mercy Health was the culmination of "probably several months" of negotiations.
For the first time, Anthem acknowledged publicly that St. Louis-based BJC HealthCare, which is the largest employer in St. Louis area, had been excluded from the Anthem's networks for individual health plans. BJC runs Barnes-Jewish Hospital, St. Louis Children's Hospital, Christian's Hospital, and other hospitals in the St. Louis area.
St. Luke's Hospital in Chesterfield has also been excluded from Anthem's network for individual plans.
Certain insurers such as Anthem are excluding higher-priced providers from some of their networks to reduce the payout for medical bills and help keep monthly premiums lower. Wiethop said that Anthem officials were continuing to hold discussions with BJC HealthCare as well as St. Luke's about their medical charges and potential inclusion in Anthem's Pathway and Pathway X networks. "We're in constant communications with BJC," she said.
Anthem provided on Friday a copy of a "current list," dated Oct. 8, of those health providers who are part of its Pathway and Pathway X networks in the state of Missouri.
That list, which is available online at www.stltoday.com/business, has about 60 hospitals in various parts of the state. In the St. Louis area, it includes St. Anthony's Medical Center, St. Alexius Hospital, several SSM Health Care facilities, and two hospitals operated by Tenet Healthcare Corp. -- St. Louis University Hospital and Des Peres Hospital.
The new health insurance marketplace -- the online exchange run in Missouri by the federal government -- offers residents on the Missouri side of the St. Louis area about two dozen individual member health plans from only two insurers: Anthem, and Maryland-based Coventry Healthcare.
Anthem's rates appear to be higher, and its provider networks for individual policies are likely to be more restrictive in terms of consumer choice, according to a federal database of insurance rates and local health insurance brokers.
Coventry offers its individual customers in the St. Louis area the choice between "performance" plans with a highly restrictive network and "PPO" plans that include a broader choice of health providers; the PPO plans have a higher monthly premium.
Asked whether there is still a possibility that other health providers will be added to Anthem's individual plans in Missouri in 2014, Wiethop responded: "We will continue to add where we can. ... The (monthly premium) rates will stay the same."
Tara Kulash of the Post-Dispatch contributed to this report.