WINCHESTER — Mary Mcmahon has had multiple emergency surgeries in recent years and has been told she may need more procedures. All of her doctors operate under the Valley Health System umbrella, and the only logical insurance option she says she has is Anthem Blue Cross Blue Shield.
Now, as contract negotiations regarding Anthem’s in-network status with Valley Health continue, Mcmahon is one of about 40,000 people in the region who could be faced with life-altering decisions about their health insurance coverage if a deal isn't reached.
“If they don't cut their deal with Anthem, I won’t be able to see any of my doctors or I’ll have to switch insurance companies. Because everybody, all my doctors, are tied up with Valley Health,” said Mcmahon, a Front Royal resident. “We have nowhere else to turn, so I’d have to get another second-rate insurance, which would end up costing me more in the long run even though my premiums are already ridiculous.”
The current four-year contract between Valley Health and Anthem ends at the end of this year. Earlier this month, Valley Health President and CEO Mark Nantz said negotiations were stalled over rates and Valley Health's rate of reimbursement. An Anthem official said Anthem could not agree to the rate increases Valley Health is seeking because they would make health care costs in the Winchester area some of the highest in Virginia.
Valley Health is a regional health care provider and parent company of Winchester Medical Center and five other hospitals in the region. Anthem Blue Cross Blue Shield is one of the area's largest health insurance providers.
The contract covers all of Valley Health’s facilities as well as all of Anthem’s products and services, Nantz has said. The current contract with Anthem accounts for about 20% of Valley Health’s business.
While many in the region have Anthem insurance through their employers — including school and government workers in Winchester, Frederick County and Clarke County — Mcmahon pays for hers out of pocket. And with chronic health issues, she said her family has to cut corners just to afford their insurance. Mcmahon said that prior to moving into her current home, her insurance premiums were more than double her mortgage every month.
Her costs would likely go up if Anthem is no longer in-network with Valley Health or if she has to find new health insurance coverage.
Mcmahon said if she’s forced to switch insurance companies, she would have to buy many of her medical supplies with her own money. The total cost of those supplies, she said, would be enough that she could lose her home.
Mcmahon isn't alone in her concerns. School division officials, local government officials and others insured by Anthem have expressed their apprehension about the possibility of thousands of area residents being hit with significant out-of-network costs if an agreement cannot be reached..
The Clarke County Board of Supervisors and Winchester City Council have each adopted a letter and resolution to send to Valley Health and Anthem officials to encourage them to negotiate a deal.
“The board is very concerned about the additional out-of-pocket costs our hardworking employees could face if an agreement is not reached by year end,” Clarke County Board of Supervisors Chairman David S. Weiss said in a letter to Valley Health and Anthem on behalf of the board. “The COVID-19 health pandemic has already created enough stress and anxiety for our employees, and any uncertainty related to their health insurance or health care options would be detrimental at this time.”
Winchester City Council also cited COVID-19-related issues in its resolution, but said the community’s “most vulnerable members” would feel a great impact.
“The most vulnerable members of the Winchester community, including the elderly, the immunocompromised, the financially-vulnerable, and hardworking families would be most severely affected by a disruption in the availability of affordable healthcare services,” the city’s resolution states.
Mcmahon said she and her husband frequently look at how their health insurance premiums and medical bills will impact their budget and often shop around to see what else is out there. But she “always comes back to Anthem," she said.
She added that she “wasn’t a fan” of the letter Valley Health sent to patients who would be impacted if Valley Health is no longer in-network with Anthem on Jan. 1, 2021. The letter encourages them to contact Anthem, as Mcmahon put it, to "put pressure" on the insurance company to agree with Valley Health's demands.
She said it didn’t help that she received her letter right after getting out of the hospital.
Mcmahon is hopeful the two sides will come to an agreement, but she said it is nerve-racking watching the two companies “play chicken.”
“It’s hard enough to deal with medical issues, but then to have business people argue over the money,” she said. “No one is going to make it affordable for patients, but when you have a monopoly in the area, that’s when you become the scrooge. We need competition, and Valley Health has eliminated that opportunity. When a health system does that, they control which insurance I have to use. There’s no other alternative.”
Anthem and Valley Health officials reached this week said negotiations are still ongoing. Anthem customers can continue to see their Valley Health providers in-network at this time, the Anthem representative stressed.