Adena Health will end our agreement between Adena Regional Medical Center and Anthem Medicare Advantage/Anthem Medicaid Advantage on November 2, 2023. Learn More
To Our Adena Health Medicare and Medicaid Advantage Patients:
How do retailers react when faced with higher costs? They reduce expenses. They innovate. They raise prices.
Like businesses across the country, the health care industry is being impacted by higher costs during these tough economic times. However, unlike your favorite coffee shop or restaurant, health care systems, like Adena Health, can’t raise prices by simply updating our menu board. That’s because the payment rates that Adena Health receives are determined by government agencies, as well as those that are negotiated with insurers. In many cases, and especially now, those rates are fixed and don’t cover the increasing cost of care.
Like other health systems across the country, we have reached out to insurers and asked them to work with us to find a fair rate that appropriately covers the costs of the care provided. Unfortunately, conversations with the Anthem Medicare Advantage Plan and Anthem Medicaid Advantage have not been productive. As a result, we have made the very difficult decision to terminate the agreement between Adena Regional Medical Center and Anthem Medicare Advantage Plan and Anthem Medicaid Advantage, effective November 2, 2023.
While the cost to provide care has risen dramatically since the last time Adena Health and Anthem discussed Medicare and Medicaid Advantage plan rates, Anthem’s payments to Adena did not adjust in response to the increased cost of care. It’s important to note that the Federal Government’s traditional Medicare program reimburse hospitals at a rate more in-line with the cost of care than health plans (Anthem, United, Aetna, etc.) that contract with the Federal Government to administer advantage programs. Talks between Adena and Anthem did not resolve the gap, so Adena made the difficult decision to end its agreement.
Information regarding how the decision affects you, as well as your Medicare Advantage Plan and Medicaid options, are below. Please know that there are available options to your current Anthem plans.
Thank you for choosing Adena Health as your health care partner. We remain focused on providing you with the quality care that you expect and deserve as we manage the economic realities of maintaining a sustainable health care system that serves our communities.
As a not-for-profit health care system, Adena provides both quality care and accessible services across the region, and works to assure the financial resources required to provide that care are available for all residents. Adena must always be mindful of the costs to administer care across its nine-county service area. Anthem’s reimbursement rates fall short of the compensation necessary to ensure the cost of care to our patients. In addition, unpaid claims, denials, and delays by Anthem, as well as its administrative burdens and vague reimbursement policies, don’t align with Adena Health’s mission, vision, or values.
No. Only Anthem Medicare Advantage and Anthem Medicaid plans are impacted.
Review the information on this page, including the list of common questions below.
Talk to an insurance broker or advisor to see if you qualify for another plan. The Medicare Advantage plans currently accepted by Adena:
Call the number on your insurance card for help with finding in-network providers.
Medicaid plans accepted by Adena Health include:
Adena must always be mindful of the costs to administer care across its nine-county service area. Anthem’s reimbursement rates fall short of the compensation necessary to ensure the quality of care that should be available to our patients.
Adena has relied on other business units to subsidize the Anthem Medicare Advantage’s and Anthem Medicaid’s reimbursement shortfalls for several years; however, given excessive inflation, staffing shortages, and supply chain issues, this model is no longer sustainable.
Adena regularly reviews its costs to ensure that it can continue to provide quality care across its nine-county footprint. Adena relies on insurers to improve their reimbursement rates to reflect the rising cost of care. The cost of providing clinical care and supplies to patients has significantly increased over the last two to three years, while payment for services provided has significantly lagged behind inflation.
Adena is paid based on patient type (inpatient or outpatient), the procedure(s) performed, or services provided and by acuity of the patient. As a result, the range of payment received varies, but is, at times, considerably less than the traditional Medicare programed administered by the federal government.
Adena Medical Group providers are still in-network with Anthem Medicare Advantage and Anthem Medicaid; patients can continue to receive care from other Adena providers if you enroll with another Medicare Advantage plan or traditional Medicare. Medicare Advantage Plans currently accepted by Adena include:
You can continue to have procedures performed at Adena facilities and by Adena providers until November 2, 2023, under your current Anthem Medicare Advantage Plan and Anthem Medicaid.
November 2, 2023.
Adena Regional Medical Center, including the ARMC regional medical centers located in/at:
Only Adena Regional Medical center is affected. Anthem Medicare Advantage and Anthem Medicaid will still be accepted at the critical access hospitals (AFMC, AGMC, and APMC) and by Adena Medical Group.
No. Only Anthem. Refer to the list of plans that are still accepted.
No. Only services provided by Adena Regional Medical Center are affected. In addition, community health partners who are not employed by Adena, but who perform procedures at the impacted hospitals, may be affected. Talk to your provider about your specific situation. Note: the current termination does not impact the physicians and providers in the Adena Medical Group (AMG).
You can transfer your records via your MyChart account; completing our online medical records request form; or by calling 740-779-7640. If you’re a patient at an Adena-affiliated partner, you may request your records by calling them directly.
To make an appointment for services provided before November 2, 2023, call your provider’s office or make an appointment online or via your MyChart account.
Charges for Anthem Medicare and Medicaid plans are split between their professional and technical components for billing; the professional component is billed on the 1500, and will still be in-network with AMG physicians, but the technical component billed on the UB will be out-of-network on the hospital side. As such, those services will be both in and out of network.
Call your provider’s office or cancel your appointment via your MyChart account.
Contact the member services number on the back of your insurance ID card to inquire about in-network providers under your new plan.
Contact your insurance broker or benefits advisor for help with switching plans.
Under the “No Surprises Act” federal law, continuity of care allows for coverage and care for patients who are:
We don’t expect that prescriptions written by Adena providers will be affected. Please verify your prescription coverage drug coverage by contacting the Adena pharmacy at 740-779-8761 or contact your pharmacist through your MyChart account.
Regardless of your insurance coverage, go to the closest urgent care or hospital emergency department for medical emergency care.
Services provided by Adena to Medicare Advantage Plan patients should be paid at 100% of the hospital’s rate received from the Center for Medicare & Medicaid Services (CMS) for Medicare and Medicaid patients not enrolled in a Medicare Advantage or Medicaid plan.
Approximately 75% of Adena’s payments come from fixed-payment, government sponsored programs—Medicare and Medicaid.
Please visit https://www.ensemblehp.com/blog/the-real-cost-of-medicare-advantage-plan-success/ for a brief, general summary of Medicare Advantage Plan hospital reimbursement rates.
While Adena Health cannot recommend individual Medicare options.
Please consider your options and note that Medicare open enrollment is from October 15 through December 7.
Please visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4287) for help with selecting the Medicare Advantage Plan that best suits your health care needs. You may also visit https://www.medicare.gov/plan-compare/ to explore Medicare coverage options in your area.
Please visit https://www.ohiomh.com/home/changeplans for help with and information about changing Medicaid plans.