With healthcare costs forecasted to jump by double digits next year, the St. Louis region’s largest healthcare provider and Missouri’s largest commercial health insurer remain at odds over how exactly each side’s consumers will pay the bill.
The ongoing stalemate between BJC Healthcare and insurance giant Anthem follows a flurry of deals struck in the last 12 months between the hospital system and three other major insurers — Cigna Healthcare, Aetna and UnitedHealthcare.
BJC warned the hospital system’s current agreement with Anthem will lapse at the end of the year, and that “services and providers at BJC HealthCare will be considered out-of-network for patients with Anthem insurance plans starting Jan. 1, 2027.”
In a letter sent to Missouri employers in July, BJC Chief Financial Officer Scott Hawig and Chief Managed Care Officer J.C. McWilliams wrote that despite opening negotiations in February, “we have not achieved the level of meaningful progress we hoped for at this stage.”
Hawig and McWilliams’s letter lists three sticking points: BJC is alleging Anthem denies claims unnecessarily, needs to streamline and reduce prior authorization requirements and isn’t paying for services in a “fair and timely” manner.
BJC said on its website that its negotiators would also seek to ensure “reimbursement rates cover the rate of inflation and rising costs.”
Visits by Anthem members to Barnes-Jewish Hospital, St. Louis Children’s Hospital, Siteman Cancer Center, Missouri Baptist Medical Center, Parkland Health Center, among others, would be deemed out-of-network without a contract in place by next year, BJC said.
Health care services provided by Washington University’s School of Medicine, a BJC affiliate, are covered under a separate legal agreement and would be unaffected by a potential contract lapse between BJC and Anthem, the hospital system said.