Lawsuit against Anthem continues, despite reprocessing 28K claims

Anthem Blue Cross Blue Shield in Connecticut is going to reprocess thousands of behavioral health claims amounting to $400,000 in payments to mental health providers, according to the state insurance department.

Three doctor groups--the Connecticut Psychiatric Society, the American Psychiatric Association and the Connecticut State Medical Society--alerted the insurance department that Anthem wasn't correctly paying their claims, including omitting payments for psychotherapy services, after an annual change in billing codes, reported the Hartford Courant.

The state insurance department investigated the issue, concluding that Anthem has been using the wrong medical billing code on 28,000 claims it processed since January, The Day reported. As a result, Anthem will begin telling affected providers about the underpayments by May 1 and will submit monthly progress reports to the insurance department on the steps it takes to rectify the matter.

But it's uncertain whether Anthem's agreement with the state will encourage the doctor groups to drop a lawsuit claiming Anthem discriminates against mental health providers.

"We're very cautious about whether this really is the 'fix' that Anthem purports it to be. We're not sure that it is," attorney Maria Pepe VanDerLaan, who represents the plaintiffs, told the Connecticut Mirror. "From our perspective, the issue is one of parity or ending discrimination in terms of how insurers treat mental health benefits as opposed to non-mental health benefits," she said, adding that the lawsuit is a "matter of national concern."

To learn more:
- read the Connecticut Mirror article
- see the Hartford Courant article
- check out The Day article