NORFOLK, Va. — Bon Secours has filed a lawsuit against Anthem Blue Cross Blue Shield, alleging that the insurance company owes more than $93 million in outstanding unpaid and underpaid claims in Virginia.
In the 25-page suit — filed in Henrico County Circuit Court — the health system claimed that Anthem Blue Cross Blue Shield had failed to pay claims "timely and properly" in Virginia, a violation of the two companies' agreement in effect since Jan. 1, 2020. Bon Secours says Anthem’s “slow pay and no-pay tactics have caused and are causing significant damage.”
The suit comes after the health system's Medicare Advantage contract with Anthem ended earlier this month and negotiations to renew the contract broke down. The impasse means doctors and caregivers in the health system will be considered out-of-network for nearly 19,000 patients who have Anthem Medicare Advantage health insurance.
The company is seeking a $93 million award of damages, as well as interest, injunctive relief and treble damages.
The suit says Bon Secours has tried for years to work with Anthem on its payment deficiencies, but the insurance company has “repeatedly ignored” them and subjected the healthcare company to “an endless stream of repetitive and unnecessary questions and data requests.”
The lawsuit says Anthem’s unpaid accounts total more than $73 million on claims greater than 30 days. And because of Anthem, the lawsuit said Bon Secours incurred more than $20 million in denial adjustments - or write-offs - since 2020.
The healthcare giant said it has tried to negotiate with the insurance company for several years but hit a stalemate. A spokesperson for Bon Secours said in a statement: “…We have exercised every possible non-legal option available to us for nearly four years to address this issue privately…”
Bon Secours claims Anthem has a pattern of not paying claims on time. The lawsuit said as of July, Anthem owes Bon Secours around $85 million in unpaid claims in Ohio and $6 million in Kentucky.
The lawsuit also pointed out that back in July, the Virginia Bureau of Insurance ordered Anthem to pay $300,000 after finding it was not processing claims timely under Virginia law.
13News Now reached out to Anthem Blue Cross Blue Shield, who responded with the following statement:
"This lawsuit is another attempt to distract from Bon Secours' decision to leave Anthem’s provider network and deny access to care for Medicaid and Medicare Advantage members. We do not agree with the allegations stated in the lawsuit.
This is the latest tactic in their efforts to demand double digit price increases from employers and individuals - in the middle of an active contract with Anthem. With these actions, they are closing off opportunities to work collaboratively, despite numerous requests to refocus the discussion and reach a solution.
As recently as last Thursday, we reached out to Mercy Health national leadership for a meeting and Friday to Bon Secours’ Virginia leadership requesting that they rescind the Medicare Advantage termination and intent to terminate Medicaid access on 10/1/23. We have not heard back. We urge Bon Secours to engage in productive discussions instead of these unproductive tactics that continue to spread misinformation and put vulnerable populations at risk."