The treatments were “experimental” and “not medically necessary,” Anthem said, according to Thurber. 'It's a game they're playing'Īlexis 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. Two years later that figure had risen to 53% – a difference of $2.5 billion.Īnthem profits were $4.6 billion in 2020 and $3.5 billion in the first half of 2021. On June 30, 2019, before the pandemic, 43% of the insurer’s medical bills for that quarter were unpaid, according to regulatory filings. Substantial payment delays can be seen on Anthem’s books. “Patients are facing greater hurdles to accessing care clinicians are burning out on unnecessary administrative tasks and the system is straining to finance the personnel and supplies” needed to fight covid.Ĭomplaints about Anthem extend “from sea to shining sea, from New Hampshire to California,” AHA CEO Rick Pollack told KHN. Nationwide, the payment delays “are creating an untenable situation,” the American Hospital Association said in a Sept. More than 40% of the claims are more than 90 days old, VCU said.įor all Virginia hospitals, Anthem’s late, unpaid claims amount to “hundreds of millions of dollars,” the Virginia Hospital and Healthcare Association said in a June 23 letter to state regulators. 24 letter to state insurance regulators, VCU Health, a system that operates a large teaching hospital in Richmond associated with Virginia Commonwealth University, said Anthem owes it $385 million. Virginia law requires insurers to pay claims within 40 days. “We apologize for any delays or inconvenience this may have caused.” “We recognize there have been some challenges” to prompt payments caused by claims-processing changes and “a new set of dynamics” amid the pandemic, Anthem spokesperson Colin Manning said in an email. Mapping coronavirus: All of the COVID-19 cases in the U.S. Hospitals say it is hurting their finances as many cope with COVID-19 surges – even after the industry has received tens of billions of dollars in emergency assistance from the federal government. But this fight sticks more patients in the middle, worried they’ll have to pay unresolved claims. Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare, the biggest health insurer, for emergency department care, AHA says.ĭisputes between insurers and hospitals are nothing new. “There’s this sense of, ‘Everyone’s distracted. Anthem has not created its own network of facilities.Īnthem 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.Īnthem, like other big insurers, is using the COVID-19 crisis as cover to institute “egregious” policies that harm patients and pinch hospital finances, said Molly Smith, group vice president at the American Hospital Association. Watch Video: COVID-19: 700,000 US deaths and still the most cases in the worldĬorrections & clarifications: This article has been revised by Kaiser Health News to correct an inaccuracy.
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