Hospitals and doctors often sue patients whose insurance didn’t pay up. A hospital might bill them for treatment they thought would be covered. They might first get a notice saying payment is pending or denied. When insurers fail to promptly pay medical bills, patients are left in the lurch. Privacy rules prevent Anthem from commenting on Thurber’s case, said Anthem spokesperson Colin Manning. “Trying to get true help was impossible.” It’s a game they’re playing,” said Thurber, 51, whose cancer was diagnosed in November. It finally covered the claim months later. She spent much of the summer trying to get the insurer to pay up - placing two dozen phone calls, spending hours on hold, sending multiple emails and enduring unmeasurable stress and worry. The treatments were “experimental” and “not medically necessary,” Anthem said, according to Thurber. Two years later that figure had risen to 53% - a difference of $2.5 billion.Īnthem profits were $4.6 billion in 2020 and $3.5 billion in the first half of 2021.Īlexis Thurber, who lives near Seattle, was insured by Anthem when she got an $18,192 hospital bill in May for radiation therapy that doctors said was essential to treat her breast cancer. On June 30, 2019, before the pandemic, 43% of the insurer’s medical bills for that quarter were unpaid, according to regulatory filings. Substantial payment delays can be seen on Anthem’s books. ![]() “Patients are facing greater hurdles to accessing care clinicians are burning out on unnecessary administrative tasks and the system is straining to finance the personnel and supplies” needed to fight covid.Ĭomplaints about Anthem extend “from sea to shining sea, from New Hampshire to California,” AHA CEO Rick Pollack told KHN. Nationwide, the payment delays “are creating an untenable situation,” the American Hospital Association said in a Sept. More than 40% of the claims are more than 90 days old, VCU said.įor all Virginia hospitals, Anthem’s late, unpaid claims amount to “hundreds of millions of dollars,” the Virginia Hospital and Healthcare Association said in a June 23 letter to state regulators. 24 letter to state insurance regulators, VCU Health, a system that operates a large teaching hospital in Richmond associated with Virginia Commonwealth University, said Anthem owes it $385 million. Virginia law requires insurers to pay claims within 40 days. Subscribe to KFF Health News' free Weekly Edition. “We apologize for any delays or inconvenience this may have caused.” “We recognize there have been some challenges” to prompt payments caused by claims-processing changes and “a new set of dynamics” amid the pandemic, Anthem spokesperson Colin Manning said in an email. Hospitals say it is hurting their finances as many cope with covid surges - even after the industry has received tens of billions of dollars in emergency assistance from the federal government. But this fight sticks more patients in the middle, worried they’ll have to pay unresolved claims. Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare, the biggest health insurer, for emergency department care, AHA says.ĭisputes between insurers and hospitals are nothing new. “There’s this sense of ‘Everyone’s distracted. It can be republished for free.Īnthem, like other big insurers, is using the covid-19 crisis as cover to institute “egregious” policies that harm patients and pinch hospital finances, said Molly Smith, group vice president at the American Hospital Association. Follow the list and Avoid Tfl denial.This story also ran on USA Today. One such important list is here, Below list is the common Tfl list updated 2022. There is a lot of insurance that follows different time frames for claim submission. ![]() ![]() One of the common and popular denials is passed the timely filing limit.
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