Patients of an independent, physician-owned healthcare organization are set to lose in-network insurance coverage provided by Anthem on Nov. 8, 2023. The Jefferson City Medical Group (JCMG) has a long history of providing care to Jefferson Citians, including thousands of state employees.
According to a letter sent by Anthem to insures who utilizes health services at JCMG, patients will no longer have coverage to which they are accustomed. The letter was sent by Anthem after Anthem refused to grant an extension on an ongoing contract negotiation. The notice has caused heightened anxiety and uncertainty among Jefferson City area patients who fear they will lose network access to their doctors or pay out-of-network prices. Out-of-network costs require higher out-of-pocket payments for patients than in-network care.
JCMG provides nearly 50% of the primary care in Jefferson City, and delivered 65% of babies born in 2022. In addition, JCMG is the only provider of certain healthcare services in Jefferson City, such as gastroenterology. If an agreement is not reached, patients in need of these services will have to drive 30 to 60 miles or further to find an in-network physician.
“The Missouri State Medical Association (MSMA) supports JCMG in their efforts to promote continuity of care with their existing patients. Forcing Jefferson City residents to go to Columbia for in-network healthcare is not a workable solution for state employees or other Anthem customers,” according to Lancer Gates, DO, MSMA President.
Anthem has been paying well below market rates for services provided to JCMG patients for a number of years. This cost cutting by Anthem is making it increasingly difficult for JCMG to recruit and retain physicians and other health care professionals to provide high quality healthcare services. The services JCMG patients have grown accustomed to during the last 30 years are at stake.Unfortunately, these actions by Anthem are not unusual. Increasing consolidation by health insurance companies and large health systems leads to less choice for patients, and is detrimental to the continued operation of independent practices like JCMG. According to a 2022 study of competition in health insurance by the American Medical Association, Anthem controls 63% of the healthcare market for Jefferson City. This outsized market share is good for Anthem profits, but bad for patient care.
“Anthem is utilizing their market power and leveraging patients to maintain below market rates. The people who suffer are patients who simply want to maintain their long-standing, trusted relationship with their physician at JCMG. We suggest Anthem customers reach out to Anthem and their employers to urge Anthem to come to an agreement or extend the negotiation period as JCMG has requested, enabling patients to maintain coverage at JCMG,” said Jeff Howell, Executive Vice President of MSMA.
MSMA, the state’s largest professional association of physicians, residents, and medical students, is dedicated to the protection of public health and betterment of the medical profession in Missouri. Visit www.msma.org.