Bon Secours Mercy Well being Virginia (BSMH Virginia), a well being system comprising 10 hospitals, filed a lawsuit Monday in opposition to insurer Anthem Well being Plans of Virginia (Anthem) for unpaid and underpaid well being claims. Anthem Well being Plans of Virginia is a subsidiary of Elevance Well being.

The lawsuit states that BSMH Virginia and Anthem signed a collection of agreements during which BSMH Virginia offers medical providers to Anthem members in trade for reimbursement from Anthem at “sure specified fee charges.” The insurer is required to pay claims between 30 and 60 days, however this doesn’t at all times occur, the supplier mentioned. BSMH Virginia alleges that Anthem owes greater than $93 million in excellent unpaid and underpaid claims. The lawsuit was filed within the Circuit Courtroom of Henrico County in Virginia.

“As well being care suppliers, we contract with medical insurance corporations (non-public payers), together with Anthem, to pretty reimburse the ministry for the price of offering high-quality care to our sufferers,” mentioned Maureen Richmond, spokesperson for BSMH Virginia, in an e mail. Richmond added that the unpaid and underpaid claims “considerably [impact] our capability to supply sustainable, compassionate, high-quality take care of our sufferers and communities.”

The insurer engages in “no-pay and gradual pay techniques,” during which sufferers and employers expertise lengthy delays earlier than receiving an evidence of their advantages and prices, BSMH Virginia alleges. One instance of this conduct is deploying its Particular Investigations Unit to make “onerous requests” for medical information and “unnecessarily” audit emergency room claims, in accordance with the criticism.

“This criticism seeks redress for Anthem’s gradual pay and no-pay techniques leading to an unlimited quantity of BSMH Virginia claims being arbitrarily denied, downgraded and/or pended, thereby forcing BSMH Virginia to spend an inordinate variety of hours responding to extreme and unreasonable requests for added data, and endeavor extraordinary efforts to safe fee of correctly payable claims for medically essential care rendered to Anthem members,” the lawsuit mentioned.

The supplier mentioned that it has tried to resolve the difficulty with Anthem since October of 2019, when the difficulty was first recognized.

“BSMH Virginia has tried for a few years to work collaboratively with Anthem to unravel its claims processing and fee deficiencies, devoting lots of of hours of worker time to conferences and calls with Anthem and researching and answering an infinite stream of repetitive and pointless questions and information requests — however all to no avail,” the lawsuit states.

As well as, the difficulty isn’t just in Virginia, the lawsuit alleges. As of July 31, Anthem owes Bon Secours Mercy Well being (the guardian firm of BSMH Virginia) about $85 million in unpaid claims in Ohio and $6 million in unpaid claims in Kentucky.

The lawsuit additionally notes that Anthem’s guardian firm, Elevance Well being, posted a $7.8 billion revenue in 2022, whereas BSMH had an general lack of $1.2 billion.

“Anthem is greater than in a position to meet the fee obligations that it agreed to with hospitals and docs, together with BSMH,” the lawsuit declared. “These repeated fee failures represent sources diverted away from BSMH Virginia’s nonprofit mission within the Richmond and Hampton Roads communities and into the pockets of Anthem’s company shareholders. BSMH Virginia can’t sit idly by and let healthcare {dollars} that belong to its neighborhood be taken away by Anthem’s refusal to honor the fee phrases in its agreements with BSMH Virginia.”

Anthem didn’t return a request for remark.

Photograph: Bet_Noire, Getty Pictures