Last August, we talked about some of the ramifications of Anthem and Premier’s year-long “trial separation.” At the time, we learned that Anthem was reimbursing its insureds directly (rather than sending payment to the providers). And, to no one’s great surprise, a number of these “lucky ducks” chose not to pass on those claims reimbursement dollars to said providers. The results were, of course, predictable:
“Now Premier wants its money, taking legal action on what Shaw called "the most egregious cases." He said most of the suits are for bills in the neighborhood of $5,000, but they range from $1,000 to a $99,000 reimbursement check, which the patient said her estranged husband left town with.” (ibid)
So what, you ask?
Well, here’s what:
“A group of local patients have (sic) filed a lawsuit seeking class action against their insurer, Anthem Blue Cross Blue Shield, claiming it failed to cover large portions of their hospital bills.” [ed: link not yet available]
Now, you may think that this has to do with the Out-Of-Network penalties which Anthem imposed during the kerfluffle.
But you would be wrong.
The real reason for the discrepancy? Well, let’s let one of the plaintiffs do the talking:
“ Williams received a bill for $108,848.88 and later a second bill for $102,649.34. Blue Cross Blue Shield of Michigan [ed: his carrier] sent him a check without an explanation that matched the first amount, and he deposited that check into his personal account …He received a second check for $8,009.76 and deposited that check…” (emphasis added)
Further compounding the problem, he subsequently ignored all the bills he received from the hospital, leading that august institution to file suit against him. Only then did he deem it appropriate to fork over the $100,000. Of course, this only covered half his balance, which is still due, and still in litigation.
Mr Williams, et al, would do well to recall the First Rule of Holes.