Anthem Called Out for Unpaid Claims

One of the largest health insurance companies in the nation is under increasing scrutiny from hospitals over allegations that it is not fully paying out claims and inappropriately denying others. Hospitals across the country are no longer contracting with Anthem over the issues, according to published reports.

When claims are not paid out quickly enough, the accounts may end up being placed with collection agencies. Individuals can be confused when contacted by an agency, thinking that their insurance had already taken care of the bill. This often leads collectors to spend time trying to contact the insurance company to get the matter settled. Any healthcare collection agency can share dozens of stories of spending hours on the phone, helping consumers get issues squared away so that the accounts can be closed.

MaineHealth has accused Anthem of not paying out $70 million in claims and will be cutting ties with the insurance company in January. Illustrating just how big this issue is, Maine Medical Center, a 637-bed facility, is MaineHealth’s largest hospital and Anthem has a 70% marketshare in the state.

Last month, regulators in Georgia fined Anthem Blue Cross Blue Shield $5 million for failing to pay claims in a timely manner.

Hospitals in Virginia and Indiana have also criticized the insurance company for not paying claims in a timely manner or paying them at all. State law in Virginia requires insurance companies to pay healthcare claims within 40 days. But 40% of the $385 million in unpaid claims at Anthem were at least 90 days old, according to published reports.

Last October, hospitals called out Anthem for owing billions of dollars in unpaid claims.

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