ST. LOUIS • After months of stop-and-start negotiations, St. Louis University and Des Peres hospitals have reached a new 4-year agreement with HealthLink Inc. and Anthem Blue Cross and Blue Shield in Missouri.

The deal ends the uncertainty for thousands of St. Louis area patients, especially some of those undergoing cancer and transplant patients on long-term treatment protocols who worried about whether they would be able to continue their treatments at SLU Hospital - or would need to be transferred to another hospital.

The managed care contract sets medical reimbursement rates and terms of service between the health insurers and the two hospitals, which are both owned by Tenet Healthcare Corp. of Dallas.

Under the agreement, Anthem and HealthLink members will continue to receive "in-network" insurance coverage for the medical care they receive at SLU Hospital, Des Peres Hospital, and related outpatient facilities.

"We're happy that we have a new contract and patients can receive uninterrupted care," said Tenet spokeswoman Carol Britton.

Without the contracts, Anthem and HealthLink customers would have paid significantly higher rates this year for out-of-network care at the two hospitals - and higher health costs would no doubt have triggered a flurry of patients fleeing to other medical providers.

About 43 percent of SLU Hospital's managed care business is covered by either the Anthem Blue Cross and Blue Shield plan or the HealthLink plan, according to the hospital. But it's unclear how many thousands of patient visits per year that represents.

The agreement caps a simmering feud between Tenet and Indianapolis-based WellPoint Inc., which is the parent of HealthLink and a licensee for Anthem and Blue Cross health plans in 14 states including Missouri.

"We are pleased to continue our relationship with Tenet," Steve Martenet, president of Anthem Blue Cross and Blue Shield in Missouri, said in a written statement issued Wednesday afternoon. "As the state's largest health benefits provider, we strive to create the best health care value for our customers through a broad network of quality health care providers."

According to WellPoint, about 1.2 million Missouri residents receive health coverage from the Blue Cross and Blue Shield and HealthLink plans. But only a small portion of those patients routinely visit SLU Hospital or Des Peres Hospital.

STICKING POINTS

Tenet officials said their negotiators had offered an initial contract proposal last summer, but made little progress with the insurers in the fall.

In early December, SLU and Des Peres hospitals had announced that, because of a breakdown in talks, they would cancel their managed care contracts with Anthem and HealthLink as of Jan. 1. However, patients covered by the Anthem contract would have continued to receive care at in-network rates until Feb. 22.

Key sticking points in the talks, Tenet's Britton said, included the reimbursement rates for medical services, including such procedures as surgical implants. The negotiators dickered on specific rates and methodologies, doing financial analyses on major aspects of the deal.

Britton said the new agreement includes a "single-digit increase" for the contractual rates of reimbursement for Tenet's hospital services.

Tenet Healthcare negotiators insisted that the agreement cover all of Tenet's outpatient facilities that are affiliated with SLU and Des Peres hospitals, as well as all of Tenet's employed physicians - demands that Anthem agreed to.

Britton said the agreement also calls for insurance coverage for "all high-end services" at SLU Hospital, including organ transplants, neurosurgery, Level I trauma care, and orthopedic surgery.

SLUCare Physicians were not affected by these contract talks. They remain in-network under their existing agreement with Anthem.

Anthem and Tenet negotiators struck their deal late Tuesday evening, and finalized remaining details on Wednesday.

Laura Keller, a spokeswoman for SLU Hospital, said the Anthem insurance coverage renewal is effective March 1, and the HealthLink renewal is retroactive to Jan. 1.

"This has been really difficult," she said. "Our determination to get this agreement signed was for all the patients who require the level of care we provide."

HARD BARGAINING

Britton said the sluggish economy played into the difficulty of the talks.

"I think everybody is tightening up a bit," she said. "They're trying to save money. We're trying to make some money."

WellPoint companies have also earned the reputation of driving hard bargains in their contract talks. In the last year or so, Anthem Blue Cross companies have engaged in numerous publicly reported contract disputes with hospitals and medical groups in California, Missouri, and other states, according to news reports.

During the holidays, the two sides stopped talking - and both blamed the impasse on the other. Anthem officials said the hospitals were demanding "substantial rate increases," and Tenet officials countered that Anthem's reimbursement rates were as much as 25 percent lower than the average rates paid by SLU Hospital's other managed care insurers.

In recent weeks, Tenet and WellPoint representatives exchanged contract proposals and counterproposals. Both sides met last month at a health conference in Boston, and the talks began to intensify. The negotiators spoke mainly on the phone, sent documents back and forth, and arranged a few face-to-face meetings.

"We had a hard time getting them to the table," Britton said, "but once we (did) we were able to work out an agreement. ... I think we are satisfied with it. We got enough of what we wanted to sign the deal."