Bon Secours Mercy Health sues Anthem over $93M in alleged unpaid claims

Bon Secours Mercy Health took its ongoing spat with regional Elevance Health plans to the next level on Monday, filing suit against the insurer alleging that it owed more than $93 million in unpaid claims.

In the lawsuit, the provider group's Virginia health systems said they have pushed local Anthem Blue Cross and Blue Shield plans to pay outstanding claims for nearly four years, first identifying the issue in October 2019. It has submitted a slew of letters, meetings and formal notices to secure the reimbursement, but this has not yielded results, according to the lawsuit.

Bon Secours Mercy Health alleges that Anthem "saw an increase in the frequency and magnitude of Anthem’s denial practices" beginning in July 2021 as it ramped up efforts to obtain unpaid claims.

After a back-and-forth that extended into the summer of 2023, "BSMH Virginia finally decided that enough was enough," according to the lawsuit.

"On July 20, 2023, BSMH Virginia wrote to Anthem that because Anthem did not appear willing to work in good faith with BSMH Virginia to resolve this matter informally, BSMH Virginia would have no choice but to avail itself of any and all legal remedies available," the health system said.

The feud between the payer and provider stretches into multiple states, and, in addition to the unpaid claims, Bon Secours alleged that Anthem pays its providers rates that are "not sustainable nor market competitive."

In a statement to Fierce Healthcare, a spokesperson for Anthem Blue Cross Blue Shield in Virginia said the health system's actions mean they are "closing off opportunities to work collaboratively, despite numerous requests to refocus the discussion and reach a solution."

As of Aug. 1, the health system has terminated its Medicare Advantage (MA) contract with Anthem in Virginia and intends to take similar action in Medicaid, the insurer said. Anthem last reached out to the health system on Thursday requesting a meeting and that they change course on the MA and Medicaid decisions.

"This lawsuit is another attempt to distract from Bon Secours' decision to leave Anthem’s provider network and deny access to care for Medicaid and Medicare Advantage members," the spokesperson said. "We do not agree with the allegations stated in the lawsuit. This is the latest tactic in their efforts to demand double digit price increases from employers and individuals—in the middle of an active contract with Anthem."

In the suit, Bon Secours Mercy Health noted that Elevance Health, Anthem's parent company, generated $7.8 billion in profit during 2022, which suggests it is "more than able to meet the payment obligations that it agreed to with hospitals and doctors."

In addition, the health system said that beyond Virginia, Anthem owes Bon Secours providers even more in unpaid claims, according to the lawsuit.

"Anthem’s slow pay and no-pay tactics have caused and are causing significant damage to BSMH Virginia," Bon Secours said in the lawsuit.