Report targets Anthem for $300 million in unpaid claims

'Flawed' insurance provider systems charging higher out-of-network prices, not responding to claims

Anthem Blue Cross and Blue Shield, the state’s largest insurance company, owes the state’s hospitals nearly $300 million in unpaid claims, according to a report released by the NH Hospital Association. It said Anthem has not followed through on promises made in 2021 to improve its handling of claims.

The report also alleges that Anthem’s internal systems are so flawed that it’s charging higher out-of-network prices for providers that are in its network; it is not responding for days or longer when providers question a claim denial; and it is breaking state law that requires some claims to be paid within 15 to 30 days.

The report alleges that Anthem’s internal benefits management system misrepresents what procedures need prior authorization. It then denies claims that are not pre-approved after saying prior authorization was not required, according to the report.

Anthem has faced similar complaints from hospitals across the country. Some have sued and others have parted ways with the insurer. Georgia fined Anthem $5 million for failing to pay claims in a timely manner, Becker’s Hospital Review reported last year.

In an email, the spokesman for the NH Insurance Department said state law prohibits the office from commenting on whether the office has received complaints about Anthem’s claim processing or has taken action against the company.

In 2021, after the hospital association first raised concerns about Anthem’s overdue payments, an insurance department spokesperson told NH Public Radio that it was aware of the unpaid claims and was monitoring the situation.

Anthem spokesperson Stephanie DuBois disputed the report’s allegation that it owes hospitals $298.3 million in unpaid claims. In an email, DuBois said too that the report fails to note that a “large portion” of unpaid claims older than 30 days have been appropriately denied and remain in dispute.

The vast majority of claims it has paid have been paid quickly, DuBois said.

She declined to say how much Anthem believes it owes hospitals.

Steven Ahnen, CEO of the Hospital Association, stood by the report.

The association began hearing complaints from hospitals about Anthem’s handling of claims in early 2021, the report said. A subsequent survey of hospitals showed “universal dissatisfaction with Anthem’s practices, procedures, and overall performance,” the report said.

This story was originally produced by the New Hampshire Bulletin, an independent local newsroom that allows NH Business Review and other outlets to republish its reporting.

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