Protecting Patient Access to High-Quality Care

Overview of health care and insurance negotiations

When a health care organization agrees to accept an insurance plan, both parties sign a contract that outlines how the organizations will work together. Insurance companies and health care providers renegotiate these contracts every 3–4 years on average to balance increasing costs of care with the need for appropriate compensation.

Contract negotiations typically cover:

• How much the health plan will pay for care (reimbursement rates), and which services are covered
• Requirements for prior approval from the health plan for care (pre-authorization)
• Guidelines for when payment may be denied

These contracts directly impact your care because they determine:

• Which providers are considered in your health plan network
• What services and providers your health plan will cover
• Your out-of-pocket costs (like copays or coinsurance)

What this means to you

BJC HealthCare is dedicated to improving the health and well-being of the people and communities we serve. Along with the acclaimed WashU Medicine, our exceptional care is ranked among the best in the nation by U.S. News & World Report:

• We operate the #1 children's hospital, St. Louis Children's Hospital; #1 adult hospital, Barnes-Jewish Hospital; and #1 cancer center, Siteman Cancer Center in Missouri
• Four of our St. Louis area hospitals are ranked in Missouri’s Top 12
• 109 of our specialties and procedures are recognized as high performing

We are committed to negotiating in good faith to ensure all patients in our community continue to have access to some of the best physicians, nurses, and medicine in the country.

If we do not reach agreement with Anthem for a new contract, services and providers at BJC HealthCare will be considered out-of-network for patients with Anthem insurance plans starting Jan. 1, 2027.

The importance of contract negotiations

Like most hospital systems across the country, BJC HealthCare is facing rising costs for both supplies and staff. We are focused on continuing to offer exceptional care and protecting access to the region’s top experts. In our negotiations, we will work to ensure:

• Reimbursement rates cover the rate of inflation and rising costs so we can continue to offer critical, high-quality services now and in the future
• Payment processes are clear and efficient to reduce claim denials resulting from prior authorization and medical necessity determination procedures

Affected hospitals and health care providers

Contract renewal negotiations with Anthem cover all BJC HealthCare organizations, including 14 hospitals and hundreds of programs and clinics. Our facilities provide services for patients in urban, suburban, and rural communities in greater St. Louis, southern Illinois, southeast Missouri, and beyond. The care provided by BJC Medical Group and WashU Medicine physicians at BJC facilities will be affected by our negotiations with Anthem.

Hospitals covered by our contract with Anthem include:

• Barnes-Jewish Hospital
• St. Louis Children’s Hospital
• Siteman Cancer Center
• Missouri Baptist Medical Center
• Alton Memorial Hospital
• Barnes-Jewish St. Peters Hospital
• Barnes-Jewish West County Hospital
• Christian Hospital
• Memorial Hospital in Belleville and Shiloh
• Missouri Baptist Sullivan Hospital
• Northwest HealthCare
• Parkland Health Center
• Parkland Health Center–Bonne Terre

• Progress West Hospital