Carbon Health, Anthem BCBS publicly spar over contract negotiations

With inflation and the lingering effect of COVID-19 in the backdrop, contract negotiations between startup provider Carbon Health and insurance giant Elevance Health have turned sour—and gone public.

In a rare peek behind the curtain at these discussions, Carbon published a blog post this week blasting the insurer for failing to "pay a living wage" for services rendered to its members in California. Elevance, which operates in the state as Anthem Blue Cross, has cut Carbon from its network as of March 17, according to the post.

In the post, the provider said it has been in negotiations with the insurer since January 2022.

"Even a meaningful increase to our reimbursement rates would not have brought us anywhere close to what Anthem currently pays other urgent care and primary care providers in California," the company wrote.

However, while Carbon is now out of the insurer's network, the provider said that Anthem has rejected every out-of-network claim submitted so far and has "refused to reimburse us for this care." 

A spokesperson for Anthem Blue Cross denied this in a statement to Fierce Healthcare. 

"Carbon Health terminated its contract with Anthem Blue Cross, and despite our good faith efforts to negotiate a new contract we were unable to come to agreement, which means Carbon is no longer in our care provider network," the insurer said. "Carbon continues to insist on excessive rate increases, which would result in higher costs for the people and businesses we serve."

The spokesperson said that Anthem "routinely processes out-of-network claims as many of our members do have out-of-network coverage as part of their benefits plan" but encouraged its members to seek providers that are in its network to avoid higher costs.

Carbon said in the blog post that it will resubmit the claims that were allegedly denied in hopes of securing approval as well as reduce or reimburse the difference for patients who have already been affected by the charges. It also said that it will guarantee Anthem members will not be charged more than its standard cash-pay rates.

Given providers' financial struggles amid inflationary pressures as well as the pandemic, a spokesman for Carbon said to expect to see similarly contentious negotiations in the future.

"I think this is a sign of things to come certainly coming out of the COVID period and the aftermath of this economically for both payers and providers," the spokesperson said. "Unfortunately, these disputes really impact patient care."