Major Health Systems are Latest Victims in Growing Trend of Insurers and Payors Refusing Reimbursement

Major healthcare and hospital systems are the latest victims in the growing trend amongst insurers and payors who are refusing to reimburse health care providers for their services. Most recently, Valley Health System (“Valley”) filed suit against Anthem Blue Cross Blue Shield (“Anthem”) in the Circuit Court of Winchester, located in the State of Virginia. Valley alleges that Anthem owes it $11.4 million in past due payments in accordance with the parties’ contract. As this lawsuit demonstrates, even large health care systems are not immune from the non-payment or underpayment practices of major insurers and payors. Unfortunately, when a payor refuses to reimburse these providers, it affects the entire health system’s ability to provide optimal care to their patients.

Like the Valley Health System v. Anthem case, in September 2022, three New Jersey hospitals owned by CarePoint Health filed suit against Horizon Blue Cross Blue Shield of New Jersey seeking $76 million in past due payments for the period of June 2015 and September 2016, per the parties’ contract. Similarly, in June 2022, East Liverpool City Hospital (“East Liverpool”) located in Ohio and owned by major health system Prime Healthcare filed suit against Aetna Health for breach of contract. East Liverpool is seeking more than $6 million in unpaid claims alleging that Aetna refused to pay for medical services provided to Aetna’s members, in breach of the parties’ contract. As these recent examples illustrate, many large insurance companies and payors are failing to correctly and timely reimburse providers, including large hospital systems.

Litigation is becoming increasingly necessary to ensure that providers are properly paid for their services. Multi-billion-dollar payor conglomerates will continue to refuse to reimburse hospitals and doctors for their services unless swift and decisive action is taken by providers to ensure that payors are living up to their contractual reimbursement obligations. Whether your hospital or practice is in-network or out-of-network, you deserve to be paid properly for your services. Nevertheless, more and more payors are developing policies and implementing practices to make it nearly impossible for you to get properly and timely paid. Litigating payor-provider disputes has become a necessary and effective means to ensure not only that you are properly compensated, but also that your patients get the best level of care and benefits to which they are entitled.

How Frier Levitt Can Help

Frier Levitt represents providers across the U.S. in challenging abusive payor reimbursement practices. Our attorneys have extensive knowledge with provider-payor relationships and the tactics employed by payors to underpay or refuse to pay providers for their services. Contact us to speak with an attorney about how your practice may leverage applicable state and federal laws and regulations to ensure you receive the full compensation that you deserve for your services.

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