Valley Health Sues Anthem Over ‘Egregious' Reimbursement Delays

By Sarah Vogelsong, Virginia Mercury

October 13, 2022

Valley Health, the largest health system in the northern Shenandoah Valley, is suing Anthem Blue Cross and Blue Shield in Virginia over what it calls “egregious delays” in some of the insurer’s reimbursements for medical services.

According to the lawsuit, which was filed in Winchester Circuit Court Thursday, Anthem has failed to reimburse Valley Health for more than $10 million in services delivered to Anthem members since 2019.

In an accompanying press release, Valley Health President and CEO Mark Nantz said the reimbursements the health system is seeking equal $11.4 million.

“Anthem’s ultimate parent is a for-profit company with annual revenues of over $100 billion,” the lawsuit states. “It is more than able to meet the payment obligations that it agreed to with hospitals and doctors, including VHS.”

Colin Manning, a spokesperson for Anthem parent company Elevance, said in a statement that the company is aware of the lawsuit and believes some of its claims “have been inflated based on inaccurate and incomplete data.”

“It is a standard industry practice to review claims for medical services to ensure they are coded and billed appropriately,” he wrote in an email. “Anthem Blue Cross and Blue Shield in Virginia strives to process claims as quickly as possible and in accordance with our agreements, while also verifying billing accuracy, which requires the cooperation of our provider partners.”

An update issued by Valley Health Thursday said payment delays jeopardize health care access in the Shenandoah Valley, where it operates six hospitals including the Winchester Medical Center.

“Not-for-profit health systems like Valley Health operate on thin financial margins as is because our mission is community-driven, not investor driven,” the update said.

Valley Health and Anthem signed their last contract in December 2020 after lengthy negotiations over issues including Valley Health’s reimbursement rate, according to The Northern Virginia Daily.

Anthem is one of the largest insurers in Virginia. Manning said the lawsuit “in no way impacts access to care, and Anthem Blue Cross Blue Shield members may continue to receive care at Valley Health.”

Carol Weare, a spokesperson for Valley Health, also emphasized that “Valley Health patients covered by Anthem health plans will not be impacted and may continue to receive care at Valley Health hospitals, facilities and care providers.”

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This story was originally published by the Virginia Mercury. For more stories from the Virginia Mercury, visit Virginia Mercury.com.