Stanford alleges Anthem owes $1.9 millon under implied contract


Stanford Health Care sued Anthem in federal court on Friday, alleging the insurer’s failure to pay nearly $2 million owed under a national, reciprocal claims network violates an implied contract between the two.

The not-for-profit health system claimed its physicians cared for six patients insured under Blue Cross and Blue Shield of Indiana plans from 2018 to 2020, but they still haven’t received full reimbursement for their “usual and customary” rates. Anthem operates Blue Cross and Blue Shield plans in 14 states, including Indiana.

Because patients were covered under an Anthem affiliate, the suit said that Anthem Blue Cross is responsible for the cost of their care under its BlueCard program, which allows members to receive care while traveling or living in another plan’s service area. The complaint said that Anthem receives discounted rates for services provided by Stanford physicians through this program.

The six individuals’ bills mounted to more than $2 million, according to the complaint. To date, Blue Cross and Blue Shield of Indiana has paid only $78,771 for these individuals’ care, leaving Stanford in the red for more than $294,000 after the “written contract” discount is applied, the suit said.

If the court court decides that the contract is legally enforceable, the Palo Alto, Calif. health system is seeking reimbursement for $215,000 plus interest or, “should it be found no contractual relationship exists,” Stanford is requesting $1.9 million in fees for these patients’ care. In either case, Stanford is also seeking to be reimbursed for the costs of filing the suit and any other relief the court grants.

The claims mirror a complaint that Stanford Health Care filed against Blue Cross Arkansas in January, alleging the insurer dodged paying more than $100,000 due for patient’s care under the BlueCard program. Lawyers for the Arkansas Blue Cross affiliate filed to a motion to dismiss the case on April 15, saying that the lawsuit exceeded the statute of limitations, Blue Cross did not request the care provided and that Anthem never contacted the insurer about the claims.

Stanford and Anthem did not respond to interview requests.


Source: modernhealthcare.com

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