No deal between CommonSpirit Health and Anthem Blue Cross and Blue Shield of Colorado means as of midnight Tuesday, some 7,800 El Paso County residents may have to find other doctors or pay higher costs for medical services.

Failure of the the health system and insurer to reach a contract agreement bumps CommonSpirit’s hospitals, clinics and doctors’ practices into out-of-network status with Anthem.

Anthem’s commercial, Medicare Advantage and self-insured patients now will be billed higher out-of-network charges for services at Penrose and the two St. Francis hospitals in Colorado Springs, along with two locations of Endoscopy Centers of Colorado Springs, CommonSpirit Home Health Penrose-Colorado Springs and CommonSpirit Orthopedic & Spine Specialists.

About 7,800 Anthem members have recently received care at a CommonSpirit facility in El Paso County, according to Anthem. Statewide, 40,000 patients will be affected, according to CommonSpirit.

CommonSpirit had requested a “temporary contract extension,” a Wednesday morning statement from the nonprofit healthcare system said.

But Anthem said in a statement issued Wednesday afternoon that after what it considers “months of unreasonable reimbursement requests,” the one-week extension CommonSpirit wanted was unacceptable and refused the offer.

“Short-term solutions will only cause more confusion for our members,” Anthem’s statement reads. “CommonSpirit has established a pattern of disrupting care for its patients as a negotiation tactic to demand unreasonable price hikes. CommonSpirit recently used this tactic in Arizona, California and Nevada — leaving other health plans’ networks for as long as 45 days.”

Negotiations would have continued under an extension, which “would allow us to provide in-network services to Anthem members while we work to reach an agreement,” CommonSpirit said.

Colorado’s Insurance Commissioner Michael Conway urged Anthem and CommonSpirit to “remain at the negotiating table to reach a deal to bring CommonSpirit back in-network for consumers enrolled in Anthem health plans.”

“Anthem and CommonSpirit … must be cognizant that increased health care costs are ultimately borne by those same consumers in increased premiums,” Conway said Wednesday in a news release. “We have all worked very hard to keep health care costs under control for the benefit of Coloradans — it is important that work continues in these negotiations.” 

An informational website is at www.anthemcommonspirit.com, where patients can learn more about the efforts to protect their access to care. Patients also can call 1-877-213-7081 to receive personal assistance.

The dispute is over money, and each side blames the other for the pair’s inability to agree on a new contract.

Anthem “offered a multi-year agreement that includes reasonable reimbursements rates and affordability,” Matt Pickett, the company’s plan president for Colorado, told The Gazette on Tuesday.

He said he could not go into specifics of the deal but that “the cost increases they’re asking for are much higher than the rate of inflation.”

CommonSpirit’s Dr. Oswaldo Grenardo, chief medical officer for the health care system’s mountain region, said in an interview on Monday that his organization is seeking “a fair and reasonable contract” and that its operations also are battling inflation costs.

And as a nonprofit, CommonSpirit reinvests revenue in its facilities and services, Grenardo said.

“Reasonable reimbursements from large insurers like Anthem allow nonprofit hospital systems like CommonSpirit Health to retain healthcare professionals, ensure access to providers and continuity of care, sustain and introduce new services to the community, invest in technologies, and maintain our premier facilities throughout the state,” according to CommonSpirit.

While contract negotiations are a normal course of business between health systems and insurance companies, Pickett said this go-round differed in that CommonSpirit had asked Anthem for contract increases that “will make the affordability worse for customers.”

“Given the fact that 80% are covered by self-insured health plans, meaning their employers pay for their medical bills, further (contract) increases would increase costs,” Pickett said.

He said he could not detail how much costs could rise, although expenses for insurance coverage would likely go up. 

CommonSpirit views the situation as “having an insurer interfere with the doctor-patient relationship, which is problematic,” Grenardo said.

CommonSpirit replaced Centura Health last year in managing the health care system, which had included AdventHealth. That part of the organization split off and has retained its own brand and operations.

Pickett noted that Anthem was able to reach a contract deal with AdventHealth.

“CommonSpirit is already a high-cost provider,” Pickett said.

Grenardo said CommonSpirit has been seeking “a different type of contract that’s going to help us overcome inflation so we can provide the care we need to across the state. We don’t have shareholders, we have patients, and we reinvest our money back into the patients.”

Another primary hospital system, UCHealth, failed to reach an insurance agreement with Anthem in 2021 for patients in the Denver area but since has come back in-network.