By Tim Bonfield
The Cincinnati Enquirer

Thousands of area residents covered by Anthem Blue Cross and Blue Shield may find themselves unable to use services from the Health Alliance of Greater Cincinnati next year because of an unresolved contract dispute.

A multiyear contract between Greater Cincinnati's biggest health organization and one of the nation's biggest Blue Cross insurers expires at year's end.

The Health Alliance - which includes the Christ, University, Jewish, St. Luke and Fort Hamilton hospitals - wants more money. Anthem - which covers more than 12 million people in nine states - says the Health Alliance is asking for too much.

In recent days, area residents have received letters from Anthem warning them that the Health Alliance might not be part of Anthem's health networks next year. Some people also have received a letter from the Health Alliance. However, many of the 370,000 who might be affected have not received notice from either side.

The initial contract termination notice was sent by the Health Alliance, Anthem officials said. Neither will publicly discuss specifics.

"We are in negotiations with Anthem. We are hopeful that we can come to agreement with them, but there's never a guarantee. Often these negotiations come down to the wire," said Health Alliance spokeswoman Gail Myers.

Earlier this year, Health Alliance officials said they need to pump about $500 million into new equipment and facility improvements in the next five years to keep up with rapidly advancing medical technology.

For the past several years, tight reimbursement rates from big insurers have limited the system's ability to reinvest in services, Health Alliance officials said.

"We want to be in their panels, but we also need payments that cover our costs and give us enough of a margin to keep our facilities and equipment up to date," Myers said.

Anthem spokesman Joe Bobbey said the company sent out letters to some members - he would not specify how many - because Anthem's contracts with their employers require a 30-day notice. People in plans that did not require notice have not received letters.

"Anthem Blue Cross and Blue Shield is continuing to work with the Health Alliance to reach a positive resolution," Anthem's warning letter states. "However, it is possible that a resolution will not be finalized prior to Dec. 31. ...

"Anthem's responsibility to the community is to negotiate fair provider contracts that are in the best interests of you and your employer."

It is not clear how many residents would be affected. But thousands of people covered by Anthem who have doctors with the Alliance Primary Care might have to choose a new doctor if no deal can be reached.

The Health Alliance has sent a letter dated Dec. 1 to Alliance Primary Care patients.

"You may have received a letter from Anthem stating that the contract is being terminated and that Alliance Primary Care will no longer be part of the Anthem network of providers. They are legally required to send this notice by Nov. 30 if negotiations are not concluded, but there still is a likelihood that we will be part of the plan.

"Anthem's letter may have advised that you must choose a new primary care physician by January 1. This is not your only option."

If no contract agreement is reached, people could drop Anthem and enroll in another plan - if a choice is offered by the employer, the Health Alliance letter states.

Depending on the plan a person has, Anthem officials say some people may be able to stay with Health Alliance hospitals and doctors, but would have to pay higher copayments and deductibles.

For more information, call Alliance Primary Care at (513) 585-9009 or the toll free member services number on the back of your Anthem ID card.

E-mail tbonfield@enquirer.com