Patient First operates several locations around town, including one in Carytown. Photo by Brandy Brubaker.
Another local healthcare chain has reached an impasse with the state’s biggest health insurer over reimbursement rates.
Glen Allen-based Patient First, which operates more than 60 urgent care clinics around the mid-Atlantic, has stopped accepting new patients insured by Anthem, HealthKeepers and Blue Cross Blue Shield.
The change, which took effect Feb. 2, also includes all Anthem members with HealthKeepers Plus plans, even people who are existing patients at Patient First.
Patient First claims Anthem wants to cut reimbursement rates for services provided to patients with Anthem insurance.
“The costs for delivering care increase year over year,” Patient First spokesman Ian Slinkman said in an email. “Every one of the other Virginia payors with whom we contract understands this and provides reasonable trend increases that enable us to maintain our high levels of access and service.
“Anthem instead insists on reducing our reimbursement back to 2012 levels.”
Anthem previously had a similar dispute with Bon Secours. Photo by Evelyn Rupert.
In an email conversation Wednesday, Anthem spokesman Scott Golden said the company pays Patient First the same reimbursement rates it pays other healthcare providers in Virginia.
“Patient First has indicated the current level of reimbursement from Anthem, and the lack of guaranteed annual fee increases, put Patient First in an unsustainable position,” Golden said.
But he said the action by Patient First violates its provider agreement with Anthem.
Patient First said in an online statement that the dispute over rates has been going on for years.
“In order to provide our patients with the best care possible, we have always protected ourselves against unreasonable reimbursement practices that would prevent us from preserving the breadth and quality of our services.
“We have been working to resolve this situation for more than two years and only reached this difficult decision after months and months of unproductive discussions with Anthem.”
Anthem was previously in a similar a tug-of-war with Bon Secours Virginia Health System over similar rate reduction grievances. That dispute resulted in each side take shots at the other but was ultimately resolved with a new contract.
Golden and Slinkman gave different answers as to whether Anthem and Patient First were in talks to find a resolution.
“We remain in discussion with Patient First and are working hard on our customers’ behalf to reach a resolution,” Golden said.
But Slinkman said that as of Tuesday afternoon, no talks were going on between the two parties. He did say that Patient First is “open to a reasonable resolution and to minimizing the effect on current and future patients.”
“Our goal is to preserve our ability to make available and provide the kind of safe, convenient, and cost-effective care our patients have experienced and come to expect,” Slinkman said.
Patient First’s new policy will affect two categories of Anthem members:
• New patients, who have never been to Patient First previously, who are members of Anthem, HealthKeepers and any BlueCross BlueShield plans, excluding CareFirst BCBS.
• Any patients enrolled in Anthem’s Medicaid/FAMIS program, HealthKeepers Plus.
Patient First currently accepts patients with plans from CoventryCares of Virginia, InTotal Health, Virginia Premier and Optima Family Care.
Matt Chaney is a reporter with VCU’s Capital News Service.
Patient First operates several locations around town, including one in Carytown. Photo by Brandy Brubaker.
Another local healthcare chain has reached an impasse with the state’s biggest health insurer over reimbursement rates.
Glen Allen-based Patient First, which operates more than 60 urgent care clinics around the mid-Atlantic, has stopped accepting new patients insured by Anthem, HealthKeepers and Blue Cross Blue Shield.
The change, which took effect Feb. 2, also includes all Anthem members with HealthKeepers Plus plans, even people who are existing patients at Patient First.
Patient First claims Anthem wants to cut reimbursement rates for services provided to patients with Anthem insurance.
“The costs for delivering care increase year over year,” Patient First spokesman Ian Slinkman said in an email. “Every one of the other Virginia payors with whom we contract understands this and provides reasonable trend increases that enable us to maintain our high levels of access and service.
“Anthem instead insists on reducing our reimbursement back to 2012 levels.”
Anthem previously had a similar dispute with Bon Secours. Photo by Evelyn Rupert.
In an email conversation Wednesday, Anthem spokesman Scott Golden said the company pays Patient First the same reimbursement rates it pays other healthcare providers in Virginia.
“Patient First has indicated the current level of reimbursement from Anthem, and the lack of guaranteed annual fee increases, put Patient First in an unsustainable position,” Golden said.
But he said the action by Patient First violates its provider agreement with Anthem.
Patient First said in an online statement that the dispute over rates has been going on for years.
“In order to provide our patients with the best care possible, we have always protected ourselves against unreasonable reimbursement practices that would prevent us from preserving the breadth and quality of our services.
“We have been working to resolve this situation for more than two years and only reached this difficult decision after months and months of unproductive discussions with Anthem.”
Anthem was previously in a similar a tug-of-war with Bon Secours Virginia Health System over similar rate reduction grievances. That dispute resulted in each side take shots at the other but was ultimately resolved with a new contract.
Golden and Slinkman gave different answers as to whether Anthem and Patient First were in talks to find a resolution.
“We remain in discussion with Patient First and are working hard on our customers’ behalf to reach a resolution,” Golden said.
But Slinkman said that as of Tuesday afternoon, no talks were going on between the two parties. He did say that Patient First is “open to a reasonable resolution and to minimizing the effect on current and future patients.”
“Our goal is to preserve our ability to make available and provide the kind of safe, convenient, and cost-effective care our patients have experienced and come to expect,” Slinkman said.
Patient First’s new policy will affect two categories of Anthem members:
• New patients, who have never been to Patient First previously, who are members of Anthem, HealthKeepers and any BlueCross BlueShield plans, excluding CareFirst BCBS.
• Any patients enrolled in Anthem’s Medicaid/FAMIS program, HealthKeepers Plus.
Patient First currently accepts patients with plans from CoventryCares of Virginia, InTotal Health, Virginia Premier and Optima Family Care.
Matt Chaney is a reporter with VCU’s Capital News Service.
Thank you for reporting on this crisis RBS. I can certainly understand all of the perspectives on this challenge. As the CEO of the largest pediatric practice in Richmond (Pediatric Partners of VA – @ppvkids), my observation is that primary care providers such as ourselves are under immense pressure as our costs to do business continue to rise. Payers pressure us daily with reimbursements that are flat or offer increases that don’t keep pace with inflation or the cost of living, as well as crafting new payment models that don’t properly incentivize excellent care. As a small business and employer,… Read more »