On April 1, University of Missouri students on Anthem Blue Cross Blue Shield insurance plans received an email from MU Health Care informing them that their facilities were no longer in-network. These students are among more than 90,000 MU Health Care patients affected by this out-of-network period with Anthem.
The shift follows eight months of negotiation between MU Health Care and Anthem, which ended in both parties failing to reach a contract agreement on healthcare pricing. Prescriptions provided through Mizzou Pharmacy and medically necessary emergency care will still be treated as in-network for students with Anthem Blue Cross Blue Shield insurance.
MU Health Care staff said that the reimbursement rates Anthem offers their facilities are too low and do not account for inflation and price level shifts. Anthem rejected MU Health Care’s proposal of a 39% price increase over three years.
MU senior MJ Montgomery said she has foregone healthcare since the split due to concerns over pricing.
“In March, I had a vaccination appointment, and I missed my appointment for some reason or another, and two weeks after I missed my appointment, before I had the chance to reschedule it, they dropped us,” Montgomery said.
Montgomery said that the vaccination would have been free under Anthem’s coverage. Now, it would cost $700 to get with MU Health Care out of network.
Transportation is another concern for newly out-of-network students. MU sophomore Gordon Lynch said they are aware of off-campus services but struggle to access them.
“I feel like [MU Health Care] is pretty important right now as somebody who lives on campus,” Lynch said. “Especially without having a car, it’s hard for me to be able to do anything off campus.”
Lynch said they did not receive an email informing them about the discontinuation of Anthem service. Because Lynch is covered by Aetna’s insurance program as well as Anthem, they believe conflicts between the companies over payments may result in a loss of coverage.
“My insurances kind of fight over who has to pay … Aetna is being forced to pay and they’re probably gonna refuse to pay, so I don’t know what I’m gonna do in the future,” Lynch said. “I will probably not be going into any appointments until that’s figured out.”
Spectrum Health Care, a Columbia non-profit clinic, said as of April 18, they have experienced an approximately 30% increase in patients since the termination of Anthem Blue Cross Blue Shield contracts with MU Health Care. According to Spectrum’s staff, many of these patients identified Anthem as their insurance provider when setting up appointments.
After the contract termination, patients of MU Health Care scheduling or arriving to appointments at MU facilities were notified that it would be their last in-network service, according to Becky Acton, the executive director of Spectrum Health Care.
Spectrum, which operates from a single facility, receives patients from Jefferson City, Mexico, Sedalia and rural communities across Missouri. As of April 18, Spectrum is booked through mid-July for new patient appointments.
Spectrum’s clinic provides primary care and family planning services but does not provide emergency care. Like MU Health Care, they negotiate prices and contract with Anthem.
“We have to negotiate, because otherwise the insurance companies would take over determining the expense. And they’re not really the best to determine that,” Acton said.
Negotiations between MU Health Care and Anthem Blue Cross Blue Shield have also caused confusion among MU international students, who are required to enroll in the Anthem Student Advantage plan.
The Anthem Student Advantage Plan will be in-network at MU Health Care until July 31 or Aug. 15, depending on the student’s individual plan. MU is transitioning the Student Advantage plan to a different healthcare insurance provider and will notify students under this plan with instructions on how to enroll before the Fall 2025 semester.
In late February, MU Health Care sent an email to all patients with Anthem coverage, including those under the Student Advantage plan, informing them that they may “receive an email or hear news about potential changes to Anthem coverage related to MU Health Care.” Some international students unfamiliar with health insurance plans in the United States are unsure if they can continue seeking healthcare at MU facilities.
“I come from Sri Lanka, and in my country, we have free healthcare … because of that, we don’t have mandatory insurance plans,” said Erandika de Silva, a graduate student at the MU. “No matter how many questions we ask, it’s kind of difficult for us to be familiar with the system.”
MU International Student and Scholar Services offers a workshop and resources for international students to learn about the U.S. health insurance system. However, de Silva said that she and other international students she knows are still uncertain about what payments like a deductible are and when it takes effect.
“For international students, it’s important that they know beforehand that this particular hospital is an in-network provider,” de Silva said. “Most of us are pressed for money, and we can’t just walk into a hospital and get a surprise bill.”
During the academic year, international students are permitted to work up to 20 hours per week, limiting their earnings to pay for such healthcare bills. In most cases, visa restrictions require international students to work on campus.
The MU News Bureau said MU Health Care remains open to negotiations with Anthem to renew their contract. MU Health Care said it is experiencing a high rate of claims denials and that 30% of Anthem’s bills to MU Health Care patients are 90 days overdue.
Anthem states on its website that it “cannot agree to price hikes” being requested and continues to offer lower payment increases to MU Health Care. The organizations have yet to reach an agreement.
Edited by Maya Dawson | mdawson@themaneater.com
Edited by Natalie Kientzy | nkientzy@themaneater.com
Edited by Emilia Hansen | ehansen@themaneater.com
Edited by Annie Goodykoontz | agoodykoontz@themaneater.com
