Mercy Health sues Anthem in Virginia, alleges $93M in unpaid claims [Springfield News-Sun, Ohio]

Aug. 31—Bon Secours Mercy Health in Virginia filed a lawsuit against Anthem Blue Cross Blue Shield, saying the insurer owes the health system $93 million in unpaid claims.

The health insurance provider Anthem has called the lawsuit "baseless," saying Mercy Health has not shared documentation showing those unpaid claims.

"Anthem failed to pay BSMH Virginia in full, accruing an unpaid accounts receivable that is currently in excess of $73 million on claims aged greater than 30 days. Additionally, these practices have led to BSMH Virginia incurring more than $20 million in denial adjustments or 'write offs' since 2020," says the lawsuit filed in the Circuit Court of Henrico County in Virginia.

"They have filed a baseless lawsuit against Anthem in Virginia, and that lawsuit alleges that we owe them $93 million in late claims payment. That's not true," said Jane Peterson, the commercial president of Anthem Blue Cross and Blue Shield in Ohio.

The figure of $93 million is not based on any claims data, Peterson told this newspaper.

"They've refused to share any data to support it," Peterson said. "If they really believe that they have been underpaid, we encourage them to share the details with us so we can work to address it."

BSMH Virginia's parent company, Bon Secours Mercy Health, is the fifth largest Catholic hospital system in the U.S., with 47 hospitals, 3,000 physicians and 60,000 associates across seven states and Ireland. Bon Secours Mercy Health invests more than $600 million in annual community benefits, the company said.

Mercy Health has medical centers locally in the Springfield area, Fairfield and southwest Ohio. Unpaid claims in Ohio and Kentucky tops that of what is owed in Virginia, Mercy Health says, but so far they have only filed a lawsuit in Virginia.

"Anthem owes Bon Secours Mercy Health more in unpaid claims in Ohio and Kentucky than it does in Virginia, and all stem from the same no-pay and slow-pay tactics outlined in the suit," said Jennifer Robinson, said Mercy Health public relations and communications manager. "Anthem refuses to pay for more than $100 million in services that have already been provided to patients covered under their plans, and that number continues to rise."

This comes after Mercy Health made Anthem Medicaid members in Ohio out-of-network in July. Mercy Health is also planning to do the same with Anthem's Medicare Advantage members in October.

This lawsuit is a distraction from those decisions, Peterson said.

"The core issue here is that Mercy Health is terminating its contract to serving Anthem Medicaid and Medicare Advantage members in order to get higher prices from our employers and our Anthem members covered by the Affordable Care Act, and that's despite us having mutually agreed upon rates in place until 2025," Peterson said. "Based on that, they're leveraging and using our most vulnerable members as bargaining chips, quite honestly, and we feel that they're playing a very dangerous game when they're doing that."

Making Anthem's Medicaid and Medicare Advantages out-of-network is disrupting care for more than 100,000 members across Ohio, Virginia, and Kentucky, with 60,000 those of those members in Ohio, Peterson said.

Hospitals have faced increased costs, a Mercy Health spokesperson said, while Anthem says the requested cost increases for its employer-sponsored and Affordable Care Act plans is too high.

The 2022 operating revenue for Elevance Health, the parent company of Anthem, grew 13.7% year-over-year to $156 billion, with its 2022 operating gain growing 12.9% year-over-year to $8.5 billion, according to its earnings report. Bon Secours Mercy Health reported an overall loss of $1.2 billion in 2022, the hospital system said.

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