Anthem Blue Cross, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims, say hospital officials in multiple states.
Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare, the biggest health insurer, for emergency department care.
Spokesperson for the American Hospital Association says Anthem and other big insurers are using the COVID-19 pandemic as an excuse to implement egregious policies that harm patients and hospital finances.
The AHA says the insurers are creating an untenable situation with payment delays.
In Virginia, Anthem owes one health system in Richmond $385 million, while statewide the unpaid claims amount to hundreds of millions of dollars.
Alexis Thurber, who lives near Seattle, was insured by Anthem when she got an $18,192 hospital bill in May for radiation therapy that doctors said was essential to treat her breast cancer.
The treatments were “experimental” and “not medically necessary,” Anthem said, according to Thurber. She spent much of the summer trying to get the insurer to pay up — placing two dozen phone calls, spending hours on hold, sending multiple emails and enduring unmeasurable stress and worry. It finally covered the claim months later.
Hospitals point to a variety of Anthem practices contributing to payment delays or denials, including new layers of document requirements, prior-authorization hurdles for routine procedures and requirements that doctors themselves – not support staffers – speak to insurance gatekeepers.
Doctors are literally leaving the patient bedside to speak on the phone with Anthem.
Anthem profits were $4.6 billion in 2020 and $3.5 billion in the first half of 2021.
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