COLUMBUS, Ohio — Patients enrolled in Anthem Medicare Advantage will no longer be covered when seeing providers at Ohio State health systems, including Wexner Medical Center and the James Cancer Institute.
It comes as Ohis State ended its contract with Anthem to serve Medicare Advantage members, meaning they will no longer be in the plan’s network.
The change goes into effect on Jan. 1, 2025, and a spokesperson for Ohio State said it will impact an estimated 28,000 patients.
In statements, each party placed blame on the other for the change.
“We have worked in good faith with Anthem for more than a year in an effort to remain a participating provider in Anthem’s Medicare Advantage network. Unfortunately, Anthem was unwilling to agree on a new, fair contract. Anthem has notified us that we will no longer be included in their Medicare Advantage network, effective Wednesday, Jan. 1, 2025. We are disappointed in Anthem’s decision to remove the Ohio State Wexner Medical Center and the OSUCCC – James from its Medicare Advantage network, and we are still interested in continuing negotiations," said a spokesperson for Ohio State.
They encourage patients who have questions or want to see a list of Medicare Advantage insurance carriers they will accept in 2025 to visit their informational website
Anthem sent the following statement to 10TV:
“In June 2024, OSU health system, including the Wexner Medical Center and James Cancer Institute, notified Anthem Blue Cross and Blue Shield in Ohio that it will no longer accept Anthem Medicare Advantage members starting January 1, 2025. Despite our efforts to keep OSU in our Medicare Advantage network at reasonable payment rates, OSU has chosen to stop serving Anthem Medicare Advantage members. We’ve taken steps to assist our impacted members, ensuring those currently in treatment for serious conditions can continue care with their current provider and helping others transition to one of the many alternative in-network care providers in Central Ohio. We encourage our members to contact our member service center at the phone number on their Anthem ID card with questions or concerns.”
Michael Gallaugher, of Columbus, was frustrated to hear about the change. He selected Anthem’s Medicare Advantage plan because he and his wife’s preferred providers at Ohio State were in the network.
“What they don’t tell you when you sign up with the network, your network may change,” he said.
Gallaugher was especially frustrated to find out toward the end of the open enrollment period that ends on Dec. 7.
“They are using their customers as pawns in a negotiating match and I find it very frustrating that the federal government, when they set up the Medicare C Advantage plan, didn’t have the foresight to determine all contracts need to be in place before open enrollment,” he said. “We are now halfway through open enrollment and I have to go looking for somebody as another carrier.”
If he does not scramble to find a new plan to enroll in, he said he will have to pay out of pocket or find new doctors, not a simple feat when he says his wife has been waiting months to see specialists.
“My wife has had to wait six months. She has two appointments with two critical, in my opinion, specialists and if she has to find someone else we are going to have to go back in the queue and wait six months again so I find it frustrating that basically the insurance company and provider network are putting us in the middle of everything,” he said.
The Department of Insurance recommends people impacted who want to continue using Ohio State's health systems to review plan options and enroll by Dec. 7.
According to the Department of Insurance, people can contact the Ohio Senior Health Insurance Information Program at 800-686-1578 for objective and unbiased plan comparisons.