OhioHealth-Anthem Contract Negotiations Impact Network Status and Patient Coverage

OhioHealth, a healthcare system operating 16 hospitals in Ohio, is approaching the expiration of its contract with Anthem on July 31, 2025. If the two parties do not reach a new agreement, OhioHealth will no longer be in-network for Anthem members starting August 1, 2025, impacting coverage for elective health services at OhioHealth facilities for those insured by Anthem. Emergency care at OhioHealth will remain accessible regardless of insurance status. Negotiations are ongoing, with OhioHealth expressing optimism about reaching a long-term contract renewal before the deadline. However, differences remain, particularly concerning Anthem's demands for contract language that OhioHealth states would complicate payment and prior authorization processes, affecting patient access and timely payment to providers. Additionally, OhioHealth cites issues with Anthem on unresolved claims worth over $6 million that are more than 60 days old, alleging Anthem's denial of claims and delayed service authorizations hinder patient care. This dispute reflects wider industry challenges in payer-provider contract negotiations, underlining the complexities of network agreements and the importance of prompt reimbursement and authorization practices. The recent resolution of a contract dispute between Anthem and Indiana-based Parkview Health demonstrates potential for agreement in similar negotiations, highlighting the critical role of contract terms in maintaining network stability and provider payment compliance.