Barnes-Jewish Hospital, St. Louis Children's Hospital, Missouri Baptist Medical Center, Siteman Cancer Center and Parkland Health Center could all become out-of-network for Anthem Blue Cross Blue Shield patients starting January 1, 2027, if BJC HealthCare and the insurer cannot finish a new contract before their current agreement lapses at the end of this year. The two sides say they are still negotiating, but as of early September, no deal has been reached, and roughly 2.1 million Missourians covered under Anthem policies are watching to see whether their access to the region's largest hospital network survives the transition into next year.
BJC opened negotiations with Anthem in February, according to reporting from the St. Louis Post-Dispatch. BJC spokesperson Laura High said the health system and Anthem are actively negotiating to renew their agreement, per the same report. BJC has accused Anthem of unnecessarily denying claims and failing to pay for services in a fair and timely manner, and the health system is pushing for reimbursement rates that keep pace with inflation and rising costs, along with streamlined and reduced prior authorization requirements.
Anthem, for its part, has acknowledged that its current agreement with BJC and its providers is set to sunset at the end of 2026, but the insurer says it remains committed to keeping BJC in its network beyond that date. In a July letter, BJC executives Scott Hawig and J.C. McWilliams wrote that negotiations had not achieved the meaningful progress they had hoped for at that stage of talks, the newspaper's report noted. Both organizations referred comment requests to their respective negotiation webpages rather than commenting directly.
A Pattern of Down-to-the-Wire Missouri Standoffs
This is not the first time Anthem has pushed a Missouri hospital negotiation to the brink. Mercy Health, the state's second-largest provider, reached a multi-year deal with Anthem in December 2024, just weeks before a January 1, 2025 deadline that would have cut off in-network access for 2.1 million Missourians, according to KSDK. That deal came after Mercy had formally notified Anthem in September 2024 that it intended to drop the insurer over disputes involving inflation adjustments and claims processing delays.
A more recent standoff did not end so smoothly. University of Missouri Health Care and Anthem went a full three months without a contract starting April 1, 2025, leaving more than 90,000 Missouri patients without in-network coverage, according to Missouri Jobs with Justice. That lapse prompted state legislative hearings in June 2025 before community pressure helped push the two sides to finalize terms in July of that year. BJC has avoided that fate with other insurers recently, having struck deals with Cigna Healthcare, Aetna and UnitedHealthcare over the past 12 months, including a new multi-year Aetna agreement for commercial plans finalized in December 2025 that averted a January 1, 2026 in-network lapse, per BJC HealthCare.
What Happens to WashU Physicians and Patient Protections
Not every BJC-affiliated service is at risk if the Anthem contract lapses. Washington University's School of Medicine services would be unaffected by a potential BJC-Anthem contract lapse because they are covered under a separate legal agreement, distinct from BJC's hospital contracts. BJC and WashU operate under a 45-year affiliation under which WashU physicians staff BJC's flagship academic centers, including Barnes-Jewish and St. Louis Children's, while negotiating their own clinical reimbursement separately, according to the Springfield Business Journal.
Missouri law also offers a safety net for patients if BJC does go out-of-network. Under Section 354.612 of the Revised Statutes of Missouri, insurers must grant enrollees up to 90 days of transitional in-network coverage at previously contracted rates when a hospital leaves the network and continued care is medically necessary, such as for pregnancy or a life-threatening illness, according to state law. The statute also bars out-of-network providers from balance-billing patients beyond standard in-network deductibles and copays during that transition window.
New State Law Targets a Core BJC Complaint
Missouri also passed House Bill 2372 in August, requiring greater transparency in insurers' prior authorization decisions and mandating real-time electronic prior authorization systems for future plan years, according to the Missouri Hospital Association. Hospital advocates backed the law specifically to reduce utilization review delays, directly addressing the kind of claims processing complaints BJC has leveled against Anthem.
The dispute is unfolding against a backdrop of rising healthcare costs nationwide. A Marsh survey — the firm formerly known as Mercer — of more than 1,800 employers forecasts that benefit costs per worker will climb by an average of 11% next year, per the Post-Dispatch's reporting. Anthem's parent company, Elevance Health, reported full-year 2025 operating revenue of $197.6 billion, a 13% increase over 2024, while serving more than 47 million members nationwide. BJC, meanwhile, operates 24 hospitals and more than 250 clinics across Missouri, Illinois and Kansas following its 2024 merger with Kansas City's Saint Luke's Health System, generating $10.7 billion in annual revenue, according to Becker's Hospital Review.
For now, BJC HealthCare and Anthem remain at odds over how consumers will pay their healthcare costs, with the January 1 deadline drawing closer and no finalized agreement in hand. Hoodline previously reported on BJC's pay shakeup tied to its post-merger integration, part of the broader cost pressures shaping the system's current stance in talks with Anthem.
