(C) Missouri Independent
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Insured without care: How Missouri law failed 90,000 patients • Missouri Independent [1]
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Date: 2025-08-05
On April 1, Anthem Blue Cross Blue Shield terminated its contract with University of Missouri Health Care, stripping in-network coverage from more than 90,000 patients.
That’s one in every 70 Missourians suddenly cut off from their doctors, clinics and hospitals.
Some patients lost access to cancer follow-up care, prenatal visits or stroke rehabilitation mid-treatment. Lawmakers heard public testimony from families facing serious care disruptions. One story, read aloud during a June 30 Missouri Senate hearing, involved a four-year-old who had undergone multiple heart surgeries and was at risk of losing her care team.
As her parent explained: “The burden this places on families like mine cannot be overstated. We’re not just talking about switching doctors. We’re talking about losing the very people that kept our daughter alive.”
The disruption was massive and statewide.
This may have been a contract dispute on paper. In practice, it was an obstruction to care.
In rural Missouri, there was often no alternative. No other OB. No nearby specialist. Many rural counties are classified as maternity care deserts, with fewer than half of rural hospitals offering obstetric services. Patients often travel hours or wait months for neurology, if it’s available at all.
When in-network coverage ends mid-treatment, many have nowhere else to go.
Missouri does have a continuity-of-care law. But it is narrow, unenforced and largely unknown. It requires no patient notice, guarantees no continued coverage and puts the burden on providers. For most, it offered no real protection.
Patients were warned months in advance that coverage could change, but notices came with no transition plan, hotline or clear options. Many expected a deal. When it didn’t come, they were left stranded and confused. Patients called in panic and waited on hold for hours. Clinics were overwhelmed. Nurses and front-desk staff bore the brunt.
One caregiver told lawmakers: “We thought someone would step in before it happened. We did not think we would be left to figure it out alone.”
As the crisis unfolded, public pressure mounted.
At a June 30 Missouri Senate hearing, MU Health’s CEO accused Anthem of refusing to negotiate in good faith. Anthem countered that it had offered temporary continuity-of-care extensions, which MU declined.
Labor unions condemned Anthem’s actions as morally unacceptable and launched town halls and petitions calling for resolution. Meanwhile, community clinics like Spectrum Health reported a 30% surge in Anthem patients, with appointment slots booked months out.
By late June, MU Health had reassigned more than 30 staff to handle Anthem-related claim backlogs. Anthem made two continuity-of-care offers, including one extending coverage through Dec. 31. MU declined both proposals, citing confusion, lack of clarity and inadequate patient protections.
MU later described the plans as unacceptable. The focus turned to liability and leverage, not those left without access.
The two sides finally reached a new agreement on July 15, restoring in-network coverage for most commercial and ACA plans, retroactive to April 1. But patients on Anthem Medicare Advantage HMO and PPO plans were excluded.
For many, the harm had already been done.
Missouri law allows patients in active treatment to request up to 90 days of continued in-network cost sharing when a contract ends. But it doesn’t require insurers to notify patients or providers to explain the option. It has no enforcement mechanism, no appeals process and no agency tasked with oversight. By late June, up to 1,000 patients were reportedly still awaiting eligibility determinations under the law.
Many patients don’t learn the law exists until it’s too late. Even when it applies, providers must initiate the request and negotiate coverage. Many plans are excluded. The law doesn’t define “active treatment” and offers no guarantee of care.
During the Missouri Senate hearing in June, representatives from MU Health Care and Anthem testified about breakdowns in continuity‑of‑care provisions. They described fragmented communication and patients experiencing access disruptions mid‑treatment. The director of the Missouri Department of Commerce and Insurance detailed how her department has no real authority over these commercial products.
A 2024 survey by the American Medical Association found that 94% of physicians said prior authorization delays care. Seventy-eight percent said it often leads patients to abandon treatment. Nearly one in four said it caused serious harm, including hospitalization or permanent disability.
These delays strain patients and providers alike. Clinics lose revenue and staff time. Families face worsening conditions, higher bills and longer recoveries. When coverage is pulled mid-treatment, patients walk away, providers lose trust and hospitals absorb the debt.
Missouri’s hospitals, especially in rural areas, already operate under chronic strain.
Other states have done more.
California allows continued care for up to 12 months. Colorado guarantees 90 days and requires 60 days’ notice. New York and Texas extend protections through pregnancy, terminal illness and emergencies, with clear billing safeguards. These laws reduce surprise billing, readmissions, and costly treatment gaps. They show what meaningful continuity looks like.
Missouri has chosen not to follow suit.
This was preventable harm. Those with the fewest options paid the highest price.
People managing cancer, pregnancy, disability or recovery from surgery were told to find new doctors, restart referrals and reschedule care. Some paid out of pocket. Others gave up treatment entirely.
Some patients were able to continue treatment. Others were dropped, billed unexpectedly or denied access entirely. Many were left navigating a maze of denials and billing codes with no clear guidance.
Despite public statements, financial disclosures tell a different story.
MU Health requested a 20 to 30% increase in reimbursement over three years, citing rising costs and a need to match peer academic systems. Anthem offered only a 3.3% increase and called it final. MU still posted a $53.5 million operating gain in early 2025. But Anthem’s parent company, Elevance Health, reported a $3.2 billion quarterly operating gain and spent $880 million on stock buybacks that same quarter.
While patients waited on hold to reschedule chemotherapy, Anthem spent nearly $1 billion on buybacks. The resources were there. The leverage to protect continuity existed. But the burden fell on those already vulnerable.
Insurers and some lawmakers argue that stronger continuity laws would raise costs or create bureaucracy. But the real burden is not on them. It is on patients. Missouri law allows insurers to end coverage without advance notice, clear explanation, or state oversight. No agency enforces patient protections.
When care is disrupted, patients must make calls, restart treatment, or go without.
Lawmakers must act. Missouri should:
Require 30 days’ notice before removing providers from networks
Extend continuity-of-care protections to at least six months
Mandate public reporting of provider terminations and affected patients
Create a standardized appeals process with clear timelines and enforcement
Empower state agencies to issue emergency orders during major disruptions
These reforms aren’t radical. Other states already have them. They work. They protect patients.
Health insurance must be more than a product. It must be a promise.
When access disappears mid-treatment, that promise is broken.
If Missouri claims to protect the insured, it must also protect the treated.
CORRECTION: This commentary was updated at 8:51 a.m. to clarify testimony at the Missouri Senate hearing in June.
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