Tenet Healthcare cuts deal with Illinois insurer as Missouri talks sputter

2012-01-20T00:00:00Z 2012-12-23T16:12:20Z Tenet Healthcare cuts deal with Illinois insurer as Missouri talks sputterBY JIM DOYLE • jdoyle@post-dispatch.com > 314-340-8372 stltoday.com

Tenet Healthcare Corp. has signed a multiple-year agreement with Blue Cross Blue Shield of Illinois, but two of Tenet's hospitals in the St. Louis area are still struggling to renew their contracts with WellPoint health plans in Missouri.

Under a new contract, Blue Cross Blue Shield of Illinois members will have access beginning March 1 to health services at St. Louis University Hospital and Des Peres Hospital, which are both owned by Dallas-based Tenet. Those patients also will not be charged "out of network" costs for access to Tenet's outpatient centers and Tenet physicians in Missouri.

But contract talks are sputtering along between those two hospitals and Anthem Blue Cross and Blue Shield of Missouri and HealthLink Inc. The two insurance companies are both WellPoint health plans, but Illinois Blue Cross Blue Shield is independent.

"Discussions on the contract negotiations continue," said Deb Wiethop, an Anthem spokeswoman in St. Louis.

WellPoint Inc., a publicly traded company based in Indianapolis, is a licensee for Anthem and Blue Cross health plans in 14 states including Missouri.

In recent weeks, Tenet and WellPoint representatives have exchanged contract proposals and counterproposals, but made little progress since last summer. Both sides met Tuesday at a health conference in Boston, but so far WellPoint has refused Tenet's request that a third-party mediator help both sides reach a breakthrough.

Negotiators failed to reach an agreement to avert an end-of-the-year contract deadline.

Wall Street analysts expect 2011 to have been a profitable year for WellPoint, which will disclose its year-end results next week.

Still, the health insurer is driving hard bargains in its 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 across the country, according to news accounts.

Some of the hospitals and medical groups have accused Anthem of hardball tactics, while the health insurer says health providers are demanding sharp price increases. In some cases, stalled or collapsed talks have resulted in the disruption of treatment for thousands of patients.

"We have not had contentious contract negotiations with any other managed care company," said Laura Keller, a spokeswoman for SLU Hospital, adding that Tenet had asked for a single-digit increase. "There's obviously some difficulty with Anthem. It's not the first time for us, and not the first time for other hospitals."

A WellPoint official could not be reached Thursday for comment.

Meanwhile, Anthem Blue Cross has had contract disputes in California with Walgreens drugstores, the Natividad Medical Center in Salinas; and the Stanford University Hospital, Lucy Salter Packard Children's Hospital, and Stanford Medical Group in the Bay Area.

In the Midwest, the health insurer has sparred with Missouri Medical Affiliates, a group of 120 central Missouri physicians; Boone Hospital Center in Columbia, Mo.; the MedCentral Health System in Ohio; Jackson Purchase Medical Associates in McCracken County, Ky.; and Western Kentucky Diagnostic Imaging.

On the East Coast, Anthem Blue Cross has had thorny contract talks with Mary Washington Healthcare in Fredericksburg, Va.; Children's Hospital of the King's Daughters in Hampton Roads, Va.; Exeter Hospital and Core Physicians of Exeter, N.H.; the Eastern Connecticut Health Network; the Eastern Connecticut Physicians Hospital Organization; and the Counseling Center of Nashua, N.H.

Des Peres Hospital and SLU Hospital announced in early December 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 will continue to receive care at "in network" rates until Feb. 22.

Without the contracts, Anthem and HealthLink customers will pay significantly higher rates for out-of-network care at both hospitals. And if that occurs, it would probably drive away many patients who would ordinarily visit Des Peres Hospital or SLU Hospital, to other competing St. Louis area hospitals that accept WellPoint's health plans.

In the meantime, some of SLU's cancer and transplant patients on long-term treatment protocols have voiced their concerns about whether they will be able to continue their treatments at the hospital or will need to be transferred to another hospital.

"As this drags on, our concern remains with our patients," Keller said, "and our hope is that this comes to a successful resolution very soon."

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