Here are three health system-payer disputes that were resolved in the last week:
1. Southeast Georgia Health System will terminate its contract with the WellCare Medicare Managed Care Plan on Dec. 8. After months of negotiations, the sides were unable to come to an agreement. The Brunswick-based health system alleges negotiations began after years of inappropriate payment claims and denials.
2. Bon Secours Mercy Health and Anthem Blue Cross and Blue Shield reached a contract agreement through 2028. The new agreement, which ends a monthslong dispute, applies to all Cincinnati-based Bon Secours Mercy Health hospitals, outpatient care centers, and physician offices in Ohio, Virginia and Kentucky for Anthem Medicare Advantage, Medicaid, employer-sponsored and exchange members.
3. Cigna Healthcare and HCA Healthcare reached a contract agreement allowing Cigna employer-sponsored and Medicare Advantage members to access HCA facilities in Tennessee and Kentucky. However, Cigna’s exchange plans remain out of network with HCA. The agreement follows a dispute that would have affected all HCA TriStar hospitals, ASCs, PSG practices, urgent care centers and imaging and cancer centers in the Nashville region.
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