JEFFERSON CITY – Jefferson City Medical Group (JCMG) and Anthem Blue Cross Blue Shield have failed to reach a contract agreement, forcing some mid-Missouri residents to switch doctors.
Beginning Wednesday, patients of JCMG with insurance coverage provided by Anthem are set to lose in-network coverage. Anthem says JCMG terminated its contract early and wants to increase the insurance company’s payments, while JCMG says Anthem won’t agree to a negotiation extension.
Anthem controls 63% of the health care market for Jefferson City, and JCMG provides nearly 50% of the primary care in Jefferson City, according to the Missouri State Medical Association (MSMA).
The MSMA says JCMG is the only provider of certain health care services in the Capital City, such as gastroenterology. If an agreement is not reached, patients in need of these services will have to drive 30 to 60 miles or further to find an in-network physician.
MSMA Executive Vice President Jeff Howell said the desire to reach an agreement is on the physicians’ minds as well.
“I hear from a lot of physicians, and they’d really like to get this wrapped up and put behind them,” he said. “Just like patients want to keep seeing their physicians, physicians want to keep seeing their patients. There’s a relationship there.”
JCMG said it met with Anthem on Monday night and has a standing offer to extend the negotiation timeframe so patients can remain in-network.
“Anthem has declined this offer and continues down a path to put patients out of network unnecessarily,” the health care company said in a statement to KOMU 8 News.
Emily Snooks, a representative from Anthem, said JCMG terminated the agreement early and is increasing its payments.
“JCMG is putting profit over patients by terminating an agreement early to demand payment increases six times the rate of inflation – increases that would directly impact costs for local members and employers,” Snook said. “To avoid disruption to our members, Anthem has offered JCMG opportunities to generate additional revenue through our industry-leading quality incentive programs. Unfortunately, JCMG has refused to agree to participate in these quality-based care delivery programs. Their choice to disrupt patient care to force these price hikes is as baffling as it is distressing for our community.”
Howell said he believes insurance companies view this process with more concern for profit, and that they lack the personal relationship physicians have with patients.
“With insurance companies, we talk about ‘covered lives.’ It’s a very transactional term,” Howell said. “Physicians use the word ‘patients,’ which is a much more intimate term that describes a relationship between two people.”