There are two counts in the lawsuit:
- Versus Contract
- Virginia’s Ethics and Fairness in Carrier Business Practices Act has been broken.
According to Valley Health, it has been working in good faith for the past two years to quietly resolve significant Anthem reimbursement concerns, including lengthy payment delays for the medical services it has provided to its members.
According to Valley Health President and CEO Mark Nantz, “Anthem has given us no alternative but to pursue legal action and use resources to recover the $11.4 million in past-due payments that are contractually owing to our health system, some of which are years past due.”
“We’ll keep doing our share to support the community and guarantee that patients can access the professionals and services offered by our healthcare system. But we need to hold Anthem—one of the biggest health insurers in the country and the source of a significant portion of Valley Health’s income—responsible for the negative effects of their payment delays, which ultimately affect our capacity to maintain high-quality community healthcare services, according to Nantz. “We will not tolerate Anthem’s continuous failure to make the payments due to our health system, which restricts our ability to provide the treatment that our patients and their members have paid for, have a right to, and require.”
Patients with Anthem health plans will not be harmed by this decision, according to a Valley Health representative.
A spokesman for Elevance Health stated in a statement that the company is aware of the case and is evaluating it.
“We want to be very clear that this action has absolutely no bearing on access to care, and Anthem Blue Cross Blue Shield members may still obtain treatment at Valley Health. Valley Health and Anthem Blue Cross and Blue Shield have a long history of working together and supporting the communities of northern Virginia, and we will keep putting the interests of our members first in all that we do, according to Elevance spokesperson Colin Manning.
“As for some of the specific assertions made, we think they have been exaggerated based on false and deficient information. Reviewing claims for medical services to make sure they are classified and invoiced correctly is normal business practise. While processing claims as rapidly as possible and in accordance with our agreements, Anthem Blue Cross and Blue Shield of Virginia also verifies the accuracy of the billing, which necessitates the assistance of our provider partners. To get this resolved as soon as possible, we will keep collaborating with Valley Health, Manning continued.