Wednesday, March 06, 2019

The More Things Change: 2019 edition

So, FoIB Steve Downey alerted us to this item at CNN:

"A woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility. A man received more than $130,000 after he sent his fiancée's daughter for substance abuse treatment."

Okay, that's (very) nice for them, but what's that got to do with the price of tea in China, or insurance, well, anywhere?

Well, these folks got these checks as a result of Anthem's (alleged) strong-arm tactics being brought to bear on non-network providers to join up. Generally, carriers pay even out-of-network providers directly (although at less than in-network rates, natch). This has the non-network providers unhappy...

What? So what's the big deal,  you ask?

Well, if you're General Hospital and your patient just got the $375,000 from Anthem, how quickly do you think said patient's going to run it down to your business office to sign it over? Or even bother to do so? And yes, you can sue the patient, but that adds to your own wait time, as well.

Yeah, that's the big deal.

What will be interesting is to see whether the plaintiffs prevail. I doubt it, since Anthem's actions don't seem to be illegal. To the contrary, it could very easily be argued that the carrier has a higher duty to the insured, since there, at least, is a contract (the insurance policy). Not so with the non-network provider.

Oh, and lest one thing that this is some crazy new tactic: well, it's not. As I replied to Steve:

"We blogged on something like this *years* ago (will take a while to dig up), so nothing new under the sun, But *does* point out the lengths to which some carriers will go to get their way."

Well, I eventually did find that (very) old post, and I was right:

"When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly ... Anthem sent reimbursement checks of four and five figures to enrollees instead.”

We'll keep you posted on this latest attempt.
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