HENRICO COUNTY, Va. (WRIC) — The fate of some Medicaid patients in the Richmond region remains up in the air as tension continues to escalate between two prominent healthcare entities.
A week after Anthem Blue Cross Blue Shield hit Bon Secours with a cease-and-desist amid ongoing contract issues, the healthcare system responded with its own lawsuit.
On Monday, Aug. 28. 2023, Bon Secours filed a complaint in Henrico County Circuit Court against the large medical insurance provider. They alleged that — just in Virginia — Anthem owes the healthcare system around $93 million in unpaid and underpaid claims.
At the beginning of August, 11,000 Anthem Medicare Advantage patients lost coverage at Bon Secours facilities. In a one-on-one interview with 8News, Anthem President Monica Schmude expressed concern regarding the now-unclear future of 35,000 Medicaid patients. The new lawsuit added fuel to the fire.
“I found out about the legal action at the same time the public find out about the legal action,” Schmude said.
The legal action was built upon Bon Secours’ claims that Anthem practiced “no-pay” and “slow-pay” tactics for nearly four years, resulting in that aforementioned multi-million dollar sum.
According to Bon Secours, the payment timeframe outlined in prior agreements rests between 30 and 60 days. The lawsuit suggests that Anthem violated this rule by delaying payments, neglecting to comply within mandated time periods. The healthcare system also alleged that the insurance provider downgraded emergency room (ER) claims.
Schmude disputed these claims, telling 8News these allegations were untrue. She fired back that Anthem believes Bon Secours up-charges ER claims.
“It escalated over a short period of time from this organization to more than 200% of what it had been before,” Schmude said.
In a statement, Bon Secours said they’ve tried to remedy this issue privately for years. They added they’re not alone and referenced an incident from July in which the Virginia Bureau of Insurance ordered Anthem pay a settlement after not processing claims in a timely manner.
Schmude believes this particular lawsuit exists solely to distract from ongoing negotiations that have impacted thousands of Virginia patients as Bon Secours seeks to increase prices mid-contract.
“Let’s get to the table to talk about solutions,” Schmude said. “Because we have great ideas we’d love to share with them. That will not be on the backs of the employers paying more.”
This conflict between the two healthcare groups isn’t new. The two parties have been battling for months as they struggle to reach contract agreements. However, according to Bon Secours, this feud actually goes back to 2019.
Patients should keep in mind that if issues are not resolved by Oct. 1, Anthem Medicaid patients will join Medicare Advantage patients in losing coverage at Bon Secours facilities. Plans can vary, so patients are urged to check with Anthem to hear specific options.