CHA is taking the fight against Anthem’s new and harmful reimbursement penalty policy to the courts.
Earlier this week, CHA filed a lawsuit against Anthem Blue Cross, seeking judicial relief from a policy under which the insurance giant would penalize hospitals when Anthem enrollees choose a doctor that is out of network, a choice explicitly allowed by their health insurance plan.
If successful, the lawsuit would immediately halt Anthem’s new practice and ultimately deem it to be illegal and void.
Several months ago, Anthem introduced a new multistate payment policy — an unjust practice that punishes patients and hospitals every time an Anthem enrollee receives hospital care from an out-of-network physician — even if the hospital itself is in the insurance company’s network — by levying a 10% reduction to the hospital’s reimbursement.
CHA’s lawsuit makes clear:
- Anthem’s policy unfairly penalizes hospitals — as the only remedy to avoid cuts to reimbursement would violate state law. California statute is clear that hospitals are prohibited from requiring physicians (and physician groups) to be part of any insurer’s network.
- It is Anthem’s responsibility to make certain that doctors are contracted with the insurance company, rather than foist that responsibility onto hospitals.
Beyond the fact that Anthem is trying to shirk responsibility for maintaining adequate physician networks and force hospitals to choose between violating state law or incurring hefty financial penalties, the policy does nothing to improve the quality of care or access to care, instead creating new hurdles for Anthem enrollees to see their providers of choice.
We’ll keep you posted as the lawsuit progresses. In the meantime, if you have any questions, contact Erika Frank at efrank@calhospital.org.
