Bon Secours Mercy Health Virginia (BSMH Virginia), a health system conducting operations across 10 hospitals, has launched a lawsuit against health insurer Anthem Health Plans of Virginia (Anthem), a subsidiary of Elevance Health. The lawsuit references unpaid and underpaid health claims assertedly owed by the insurer, amounting to a reported $93 million. The complaint was registered in the Circuit Court of Henrico County, Virginia.
Within the original agreements between BSMH Virginia and Anthem, BSMH Virginia would supply medical services to Anthem members and receive reimbursement from Anthem at certain agreed-upon payment rates. The insurer was contractually obliged to pay health claims within a window of 30 to 60 days.
BSMH Virginia alleges that Anthem resorts to “no-pay and slow pay tactics”, delaying the processing of benefits explanations and costs to patients and employers. The health provider further accuses Anthem of making excessive requests for medical records and conducting unnecessary audits of emergency room claims — causing BSMH Virginia to expend many hours responding to such requests and working on payment collection for rightfully payable claims.
BSMH Virginia claims it has endeavoured to address the issue with Anthem since its identification in 2019. The health system asserts that hundreds of hours have been dedicated to Anthem-related meetings, calls, and to managing repetitive and unnecessary data requests. Notably, the lawsuit contends that the issue extends beyond Virginia — with Anthem allegedly owing Bon Secours Mercy Health (parent company to BSMH Virginia) around $85 million in unpaid claims in Ohio, and $6 million in Kentucky.
The lawsuit simultaneously points out the fiscal disparity between the two organisations, stating that while Elevance Health, Anthem’s parent company, reported a 2022 profit of $7.8 billion, BSMH incurred a loss of $1.2 billion. The lawsuit argues that Anthem is withholding funds crucial to BSMH Virginia’s ability to serve their communities.
In response, Anthem asserts the lawsuit is a diversion tactic by BSMH Virginia, who they claim is restricting access to Medicaid and Medicare members by choosing to go out-of-network for the Anthem payer population. Anthem also suggests BSMH Virginia aims to leverage the lawsuit to negotiate double-digit prices increases from employers and individuals.
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