Anthem Threatens to Exclude Sauk Prairie Healthcare from Network

This is a “David vs. Goliath” story.

Anthem Blue Cross Blue Shield (renamed Elevance) is threatening to take away access to Sauk Prairie Healthcare doctors and services for about 2,700 area residents.

After months of negotiating an agreement for us to provide healthcare services to Anthem enrollees, this “Goliath” insurance company’s strong-arm tactics of bullying a small, independent community health system with take-it-or-leave-it terms is leaving patients in limbo about whether they need to cancel appointments and look for a new provider.

If an agreement cannot be reached by March 31, Sauk Prairie Healthcare would no longer be an in-network provider for Anthem BCBS, forcing patients to find new doctors and go elsewhere for care.

Anthem's initial proposal included a nearly double-digit decrease in payment, compared to our request for a modest increase consistent with our increased cost to provide care. As a not-for-profit community hospital, our 1.81% operating margin is reinvested back into maintaining and improving services for our patients and purchasing equipment needed to provide that care close to home. In contrast, Anthem is a for-profit organization who last year netted more than $5.5 billion. This is more than a 5% profit margin for their shareholders.

Despite our efforts to negotiate in good faith, Anthem's most recent counteroffer included an overall reduction in reimbursement, which would not cover our costs to provide care. We continue to work to reach a mutually acceptable agreement, but unfortunately Anthem’s use of delay as a negotiating tactic leaves patients to deal with the uncertainty of where they will be able to receive in-network care beginning April 1.

We are aware that Anthem consistently uses tactics like delayed negotiations and threatened network termination to force small hospitals into agreements that prioritize Anthem’s profit margins over fair and sustainable reimbursement for providers.

Since 1956, Sauk Prairie Healthcare has remained an independent, locally directed community health system. Independence ensures that we are able to make decisions in the best interest of our community. By cutting Sauk Prairie Healthcare out of their network, Anthem’s actions are an assault on your ability to see your local provider and threatening to our independence.

We remain hopeful that we will reach a fair agreement with Anthem very soon. For updates and answers to questions, visit www.SaukPrairieHealthcare.org/Anthem. Our patients with Anthem can also call our hotline at 608-643-4111.