- On November 3, 2025
Licking Memorial Proposal Threatens Affordability, Negotiations Continue
Topic: Network Updates | Companies: Medical Mutual, Mutual Health Services | Segment: Individual, Medicare, Small Group (1-50), 51-99, 100+, MEWA
Medical Mutual is in active negotiations with Licking Memorial Health System (LMHS), which includes Licking Memorial Hospital and Licking Memorial Professional Providers, to address their high reimbursement rate structure. If Medical Mutual is unable to reach an agreement that will benefit their employer groups and members, LMHS and its physician group will no longer be part of Medical Mutual’s SuperMed, ACA, Medicare Advantage networks and all Mutual Health Services networks, starting Jan. 1, 2026.
Challenging Affordability and Access to Care
Currently, LMHS is unwilling to support fair and reasonable rate practices. Medical Mutual believes this poses a significant challenge to long-term affordability and access to care in the region, as data shows the cost of outpatient services at LMHS is considerably higher than nearby alternatives.
In fact, services performed at alternate facilities currently cost an average of 20% to 30% less than those performed at LMHS facilities. Below are a few extreme examples of costs at LMHS compared to the average costs at other facilities in the region:
- Comprehensive Metabolic Lab Panel: 485% higher cost
- Abdominal CT Scan: 299% higher cost
- Lumbar Spine MRI: 180% higher cost
- Colonoscopy: 132% higher cost
LMHS sent a letter to local employers in early September stating that Medical Mutual’s proposed changes would impact their ability to provide certain services to its members. Per Medical Mutual, this is false, and nothing in Medical Mutual’s proposals would limit this provider’s ability to provide any services to its members. Medical Mutual is simply working to ensure services are reimbursed at a sensible rate and align with industry standard methodologies.
Contract Negotiations Continue
Medical Mutual has been negotiating in good faith to keep costs at a reasonable level for its employer groups and members. They remain committed to reaching an agreement that protects their members’ access to quality, affordable healthcare. Their primary responsibility remains to their policyholders, and they are working on their behalf to minimize increases in their healthcare costs. They encourage you to join them and voice your concerns directly to LMHS. Reach out to Cindy Webster, CFO at cwebster@lmhealth.org.
Planned Notifications
Medical Mutual is mailing this letter to groups with impacted members this week. As required by the Centers for Medicare & Medicaid Services, they will mail letters to all impacted Medicare Advantage (MA) members
about this potential change by Nov. 14, 2025. The remainder of member notifications will be mailed by Dec. 1, 2025, as required by law, if an agreement is not reached by that time.
For your reference, Medical Mutual prepared a list of nearby alternative in-network hospitals (and their proximity to Licking Memorial Hospital) as well as nearby physician practices.
More information will follow soon. In the meantime, please reach out to your ExpressLink representative with any questions.