Anthem settles charge for $300,000

Virginia's biggest health insurer, Anthem Health Plans of Virginia, with its Health Keepers managed care unit, paid $300,000 to settle a finding by state insurance regulators that it was not paying claims as quickly as state law requires.

In settling the matter with the State Corporation Commission's Bureau of Insurance, Anthem neither admitted nor denied violating the law.

The bureau's review of Anthem's monthly claims reports from December 2022 to February 2023 found that 347 claims of the 67,000 Anthem received were not paid within the 40 days state law requires for clean claims. Those are claims that have all the documentation and other information needed for processing and payment.

The failure to pay those claims within the 40 days could have left Anthem subject to a fine of more than $1.7 million and suspension or revocation of its license to do business.

But "in recognition of Anthem's willingness to take prompt correction action, the Bureau is willing to recommend a favorable settlement," deputy commissioner Julie Blauvelt wrote to the insurer.

In addition to the payment of $300,000, received on June 28, Anthem agreed to identify all internal issues that resulted in late payments of clean claims and to provide a list of those to the bureau by the end of July.

By the end of August, Anthem is to submit a plan detailing the steps it will take to fix those issues and, by the end of October, the company is to show that it has completed those steps.

The company must then submit monthly reports through April 30, 2024, to the bureau for review to show how well it is complying with the 40-day law.

In agreeing to the $300,000 settlement offer and the corrective action plan, Anthem President Monica Schmude said: "This offer is being made solely for the purpose of a settlement and does not constitute, nor should be construed as an admission of any violation of law."

"Anthem Blue Cross and Blue Shield strives to process and pay claims as quickly and efficiently as possible," spokeswoman Kersha Cartwright said.

"Of the claims reviewed by the Virginia Bureau of Insurance, Anthem paid over 99.99% of all claims within 40 days of receipt," she said, adding that "Across Virginia's fully insured market, Anthem processes approximately 90% of all claims within 48 hours and pays within 10 days."

The 40-day requirement dates back to 1999 legislation sponsored by Senate Majority Leader Dick Saslaw, D-Fairfax. It passed the House of Delegates and state Senate unanimously.

Dave Ress

(804) 649-6948 [email protected] @daveress1 on Twitter