Bon Secours says Anthem failed to pay $73 million in claims, suing for $93 million

by John R. Fischer, Senior Reporter | September 06, 2023
Business Affairs Insurance
Bon Secours is suing Anthem for unpaid medical claims.
Anthem Blue Cross and Blue Shield is once again headed to court, this time up against a $93 million lawsuit by Bon Secours that alleges the insurer failed to pay $73 million in claims dating back to 2019 for patient visits at its Virginia hospitals.

Bon Secours, which operates 10 hospitals statewide, filed its suit on August 28 in Henrico County Circuit Court, saying that Anthem denied, downgraded, and delayed payment for as many as 18,000 claims at one point, according to the Richmond-Times Dispatch.

This, along with the failure to negotiate a solution with Anthem and its parent company, Elevance Health, led the healthcare system to terminate its Anthem Medicare Advantage policy in July. It also is planning to do the same to its Medicaid policy with the company in October should an agreement not be reached. Its contracts for other Anthem patients are valid through the end of 2024.

“Anthem’s slow-pay and no-pay tactics have caused and are causing significant damage to [Bon Secours],” said the healthcare system in its suit.

In response, an Anthem spokesperson told the Richmond-Times Dispatch that the litigation is a distraction from the hospital system’s termination of its Anthem agreements and an attempt to increase premium prices by double-digits.

“With these actions, they are closing off opportunities to work collaboratively, despite numerous requests to refocus the discussion and reach a solution,” said Kersha Cartwright, a spokesperson for Anthem.

According to the Richmond-Times Dispatch, about one out of three Virginia residents are Anthem members. Bon Secours says Anthem is supposed to pay claims between 30 and 60 days, but by 2022, the percentage left unpaid after 90 days was almost half. It said a special investigations unit for the insurer requested medical records and unnecessarily audited ER claims. It also requested additional information on patients and treatment at Bon Secours Emporia Hospital, putting an “extreme administrative burden” on the staff there, said the suit.

By denying payments, Anthem is unfairly placing the cost of these losses on the hospitals, according to Bon Secours, which has led them to write off more than $20 million together in losses since 2020.

Others have also accused Anthem of the same problem. In April, the state of Virginia ordered it to pay $300,000 for not paying claims as fast as state law requires. Valley Health System sued it that same month for $15 million, and Anthem affiliates in Georgia and Indiana have also had to pay a fine or damages for failing to reimburse health systems, reported the Richmond-Times Dispatch.

Bon Secours says that Anthem also owes its parent company, Bon Secours Mercy Health, $85 million in Ohio and $6 million in Kentucky. The company all together lost $1.2 billion in 2022, while Elevance Health made nearly $8 billion.

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