Healthcare providers say Anthem billing issues are widespread

Underpayments, unpaid claims and other billing complications are a chronic problem for independent healthcare providers using the Anthem insurance network, according to Maine physicians and professional associations.

Medical providers are echoing some of the frustrations expressed by MaineHealth, the state’s largest hospital network, which stunned many this week when it announced that its flagship hospital, Maine Medical Center in Portland, would be leaving the network. Anthem in January.

The problems faced by individual providers go back years but have escalated since last summer, said Dr. Jeffrey Barkin, psychiatrist and president of the Maine Medical Association.

Common issues include underpayment of claims and a high proportion of claims denied, Barkin said. Recently, providers ran into issues because Anthem couldn’t recognize their national ID numbers. When people try to troubleshoot issues, Anthem’s customer service is hard to reach or unavailable, vendors said.

The issue has led some clinicians to stop accepting Anthem insurance, and the Maine Bureau of Insurance is investigating the company’s conduct in the state.

“The Maine Medical Association would like to see a harmonious relationship between providers and payers, but this type of behavior directed at hospitals, at doctors, has absolutely no place in the healthcare ecosystem,” said Barkins.

In a statement on Friday, Anthem said it is working to pay claims as efficiently and quickly as possible in accordance with contracts it has with vendors. Over the past year, the insurer processed 92% of claims within 14 days and 98% of claims within 30 days, said Stephanie DuBois, director of public relations for Anthem Blue Cross and Blue Shield in Maine.

Anthem has set up a dedicated Maine vendor support team to handle issues, DuBois added. The company did not respond directly when asked if there are widespread billing issues in Maine and why the company is unable to pay Maine suppliers on time.

“We are proud of our progress, but these are complex issues that take time to address properly and we are committed to resolving them,” DuBois said. “We have communicated our progress to Maine vendors and we will continue this direct dialogue as we continue to address these challenges.”

Maine Medical Center, the state’s largest hospital, will leave the Anthem insurance network in January over its payment practices, according to the announcement made Wednesday by MaineHealth, the hospital’s parent organization. The break would mean that patients with Anthem insurance would have to pay significantly higher fees for care at Maine Med, which would become an out-of-network provider.

In its announcement, MaineHealth said Anthem underpaid Portland hospital claims by $13 million and owed $70 million to the entire hospital network, which includes eight hospitals in Maine and one in New Hampshire. Anthem responded by accusing Maine Medical Center of overcharging for anesthesia and operating room services.

WIDESPREAD BILLING PROBLEMS

These are familiar and frustrating issues for many small practices across the state. Anthem’s billing issues have affected therapists, chiropractors, opticians, ophthalmologists and others, according to professional associations.

Lev Myerowitz, a chiropractor in Cape Elizabeth, said Anthem owed him hundreds of thousands of dollars, including COVID-19 tests provided in 2020.

“It was first a coding error, then a software billing issue. I think they have no more excuses. It’s pretty obvious that this is a clear approach to the process. company-wide,” Myerowitz said.

“I’m not the only office,” he added. “It’s statewide. Small companies have absolutely no ability to negotiate with large insurance companies. We must choose to be in network and accept the conditions provided or not to be in network. Leaving Anthem as a provider would be like not taking complete confidence.

Last month, groups that included the Maine chapter of the National Association of Social Workers convened a meeting between about 100 providers and Anthem executives to address the issue, said Chris McLaughlin, executive director of the association.

“To their credit, Anthem has dedicated staff resources specifically to Maine to help resolve the issues. For some people, it was too little, too late. Some people have made the decision to leave the Anthem Network,” McLaughlin said.

LEAVING THE NETWORK IS RISKY

Leaving the network can be risky for providers and patients. The Indianapolis company covers 54% of insured Mainers and is one of the largest health insurance companies in the United States. If doctors, therapists and others stop buying insurance, they could lose clients or force them to pay higher fees.

“We don’t know the extent of the exodus,” McLaughlin said. “We’ve heard from many social work professionals that they feel obligated to take care of this and take care of it on behalf of their clients so they don’t lose services.

Professional associations banded together last year to pressure the Bureau of Insurance to open an investigation into Anthem’s operations called a market driving review, said Bob Reed, executive director of Maine Chiropractic. Association.

The Insurance Bureau did not respond to questions on Friday about its investigation into the anthem and the involvement of trade associations in promoting the investigation.

“The office is conducting a market conduct review of Anthem, which will include a review of vendor payment issues. The review is expected to take several months. At present, Anthem has dealt with most of its backlog of claims,” office spokeswoman Judith Watters said this week.

Reed said all insurers have billing issues, but the issue seems much more prevalent in Anthem’s case. It was also a problem that seems to have largely simmered below the surface before MaineHealth and Maine Medical Center drew attention to it.

“I think the Maine Medical Center IPO really opened a lot of people’s minds to what we thought was a minor issue,” Reed said. “Every doctor will shut up. They think “it must be just me”. Situations like this make them realize that it’s not the individual doctor.


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