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.

— Contact Matt Welch at

(8) comments


Easy fix. Take away their "not for profit" status and make them pay taxes like all other businesses. That will level the playing field and force Valley Health to have to bend.

Spock Here

Paging Katie Porter! Bring your whiteboard.


Why don't you do a story on why that Valley Health is losing so many doctors ?

And the way they decided to raise the doctors fee to preform surgeries and other things there and the way they are miss treating professions to force them to leave for profit?


Because Valley Health is too big now, the area needs them more, and they know that.


How is that self-regulated, for-profit healthcare working out for you?


Monday, October 19, 2009

Will Valley Health become a monopoly similar to Carilion of the Roanoke Valley


More info can be found here about VHS ...


Monday, October 19, 2009Will Valley Health become a monopoly similar to Carilion of the Roanoke ValleyTo finally bring a conclusion to this informative mission after what I have learned of what is going on down in the Roanoke Valley with Carilion, one can easily develop a similar perception of what is taking place with the rapid growth of Valley Health in the Shenandoah Valley/surrounding regional area.  That why it’s important that the citizenry of the Shenandoah Valley be more informed on Valley Health.

It’s well known that Valley Health’s mission is to have a large presence in the regional area.  Valley Health has not hidden that fact with the $178,000,000 Winchester campus expansion, while continuing to purchase much smaller regional hospitals that appear to have a standard price tag of $30 million for a new facility.

Valley Health’s plan to build a new $30 million hospital in Morgan County, WV  to replace War Memorial Hospital in Berkeley Springs is currently getting resistance from West Virginia University Hospital officials.

WVUH-East President Albert Pilkington has a differing opinion of the events. He has been in this position since January 2009.

"We asked for the hearing because we had serious concerns about the scope of the project, and who put the bid package together," he said. "We felt the size hospital asked for in the bidding package did not fit with the state health plan or our own analysis, and we had additional questions whether we could bid on a project or specs that were designed by an unknown party."

Pilkington said WVUH-East wants to ensure a fair and independent bidding process.

WVU-H East offers more than ‘bus stop’

By Albert Pilkington III, president and CEO, WVU Hospitals-East, MartinsburgValley Health has spent a lot of money and time to develop a PR campaign aimed at discrediting our interest in providing health care for the citizens of Morgan County. Beyond all the rhetoric, I ask you to simply consider one basic concept. Do you want a hospital in Berkeley Springs or a medical bus stop for Valley Health?

Ultimately, that is the real question. Our approach will be the same as it has been in Jefferson County in that we believe in building and growing services within the community as opposed to the Valley Health model of using small hospitals as a feeding system for the big hospital in Winchester, Va.

If you are satisfied with driving to Winchester for the majority of your medical needs as if Berkeley Springs were a suburb of Winchester, then we are not your best choice. On the other hand, if you are interested in the development of your own unique community with services provided locally, then that is the approach we offer for health care.

Truly, beyond all the PR and rhetoric, this is the only real question at hand as both companies will give you a new building.

Below are other articles that have appeared in the Martinsburg Journal over the last month and half and I do not recall reading anything about this protest in any of our local media outlets: The Winchester Star, TV3-Winchester or the NVDaily.

(Correction 10/20/09, found NVD article: WV hospital project challenged, WVU-East puts brakes on plans for New War Memorial),

(Correction 10/21/09, found WincStar article: Valley Health's plans for aging WV hospital to get hearing)

Hospital hearing set for Oct. 6

By Erienne Greene, Journal Staff Writer

Posted September 27, 2009

 Approval of hospital plans urged

A resolution is passed by Morgan panel

POSTED: September 25, 2009


Delay in hospital construction upsets commissioners

By Tricia Lynn Strader / Special to The Journal

POSTED: September 21, 2009

 War Memorial construction delayed

WVU Hospitals files for hearing before panel

By Tricia Lynn Strader, Special to The Journal

POSTED: September 20, 2009

Another grave concern is “The Lucrative Life of a Nonprofit Hospital” which was a feature by Wall Street Journal blog reporter Jacob Goldstein on August 28, 2008.  Valley Health’s “charges” appear to be competitive at the present moment, but for how long?

“The Lucrative Life of a Nonprofit Hospital”

Jacob Goldstein, WSJ blogger

August 28, 2008

ROANOKE, Va. -- In 1989, the U.S. Department of Justice tried but failed to prevent a merger between nonprofit Carilion Health System and this former railroad town's other hospital. The merger, it warned in an unsuccessful antitrust lawsuit, would create a monopoly over medical care in the area.

Nearly two decades later, the cost of health care in the Roanoke Valley -- a region in southwestern Virginia with a population of 300,000 -- is soaring. Health-insurance rates in Roanoke have gone from being the lowest in the state to the highest.

Nonprofit medical centers are big business these days. Carilion Health System, in Virginia’s Roanoke Valley, had profits of more than $100 million last year, Carilion is Roanoke’s dominant health-care player, and it charges high prices for some procedures — $4,727 for a colonoscopy, which is four to 10 times what a local endoscopy center charges, the article says. The area now has some of the highest health-insurance costs in the state.

Critics say big medical centers like Carilion use near-monopoly power to charge high prices; Carilion says it needs to charge more for some procedures to subsidize other parts of its business, such as care for the uninsured. And the hospital says an HCA-owned hospital in a nearby town offers competition.

Carilion has recently started buying up local medical practices in an effort to move to a multispecialty-clinic model. The hospital CEO says this arrangement will cut down on fragmentation and improve care.

But the move has alienated hundreds of local docs, who circulated a petition and launched a Web site. Those who haven’t sold their practices to the hospital say they’ve seen their referrals plummet.

This "Nonprofit Hospitals Flex Pricing Power" is a MUST read and pay attention the epic profit increases from 2003 through 2007.  Do you remember reading about Valley Health's epic increase from 2001 through 2005?  Yes, it was an eye popping 383% increase for that time period as exact figures for 2006, 2007 and now upcoming 2008 has been an unsuccessful challenge to obtain.

Nonprofit Hospitals Flex Pricing Power

In Roanoke, VA, Carilion’s Fees Exceed Those of Competitors;

The $4,727 Colonoscopy

Thursday, August 28, 2008

Since Valley Health is a not-for-profit, why are not their financial records readily available for public inspection.  Makes you wonder, is Valley Health is trying to hide something?  For example, review Lehigh Valley out of Allentown, PA as their financials are very much unguarded for the public to review:

IRS Form 990:

Financials and Annual Reports: Financial_and_Operational_Report%7C4523


Below is a very informative video of Frank Cotter speaking to Citizens for Responsible Health-care of the Roanoke Valley speaking out against Carilion.

We are all grateful that Valley Health provides quality care for our regional area but everyone should have much concern about their growth to become the regional authoritarian of medical care and hope more individuals within the regional area will be keeping an eye on them while asking reasonable questions.

In closing, let’s all hope that Valley Health of the Shenandoah Valley doesn’t become a monopoly that is the perception of what Carilion has done within the Roanoke Valley.

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