One of the nation’s largest Catholic hospital systems and two of its affiliated imaging centers have reached a truce with insurer Anthem in a $93 million dispute.
Bon Secours Mercy Health filed the lawsuit Aug. 28 in a Virginia circuit court. Its attorneys claimed the state’s largest commercial insurer had engaged in “slow pay and no pay tactics,” resulting in an enormous volume of claims being arbitrarily denied, downgraded or pended. The suit had sought damages including an unpaid accounts receivable balance of over $73 million and $20 million more stemming from denial adjustments and write-offs.
However, the two parties have now reached an agreement one month later. Anthem and Bon Secours did not disclose details of the settlement, citing “confidentiality provisions in the contract.” The multi-year pact will provide plan members with access at all Bon Secours imaging centers, hospitals and other facilities across Ohio, Virginia and Kentucky.
“We worked together to creatively address affordability for our members and the financial needs of an important care provider,” “Anthem Virginia President Monica Schmude said in a Sept. 29 announcement. “This agreement provides long-term stable access to care at Bon Secours Mercy Health without cost increases for our members and employers.”
Anthem’s Medicare Advantage and Medicaid health plan members will now have continued in-network use of Bon Secours Mercy Health’s facilities. The insurer has agreed to cover any claims patients incurred during the period that Bon Secours was out of network for Medicare Advantage members in Virginia since Aug. 1 and Anthem Medicaid in Ohio since July 1. Additionally, the agreement will extend coverage for those using employer-based or Affordable Care Act plans until 2028.
Bon Secours Mercy Health has agreed to dismiss its Virginia lawsuit “as the organizations form collaborative teams to address claims submissions and payment processes,” according to the announcement.
“We understand that being out of network can be very difficult, and we are pleased that patients with Anthem insurance can now see our physicians and use our hospitals at an in-network cost,” added Don Kline, chief operating officer of Bon Secours Mercy Health.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.