A federal arbitrator has ordered Indianapolis-based Anthem Inc. (NYSE: ANTM) to pay $4.5 million to a group of 11 Indiana hospitals. Our partners at the Indianapolis Business Journal report Anthem’s policy of denying claims or downgrading reimbursements for emergency room visits that weren’t life-threatening was unlawful and a breach of contract, costing the hospitals millions of dollars.
The health insurer, which fought the case for two years, says it is complying with the order.
However, the hospitals say they can claim an additional $12 million for “tens of thousands of additional claims” that they say Anthem has downgraded and not paid in full.
The IBJ reports Anthem must stop using a list of diagnostic codes to downgrade and deny the hospitals’ claims. Anthem must also pay for claims that were downgraded, but a dollar amount was not issued for that set of claims. Anthem has not said whether it will pay additional damages.
“From our perspective, this is a chronic situation with Anthem, not only in Indiana, but in other parts of the country,” Alan Lash, partner at Lash & Goldberg LLP in Miami, who is representing the hospitals, told the IBJ.
The hospitals said Anthem’s practice adversely impacted 60% to 70% of the ER claims submitted between January 2017 and May 2020.
You can read the full story from the IBJ’s John Russell by clicking here.