Health care providers say Anthem’s billing problems are widespread

Anthem offices in South Portland. Shawn Patrick Ouellette/Staff Photographer

Underpayments, unpaid claims and other billing complications are a chronic problem for independent health care providers who use Anthem’s insurance network, Maine doctors and professional associations say.

Medical providers are echoing some of the frustrations expressed by MaineHealth, the state’s largest hospital network, which surprised many this week when it announced its flagship hospital, Maine Medical Center in Portland, would leave the Anthem network in January. .

The problems facing individual providers go back years, but have multiplied since last summer, said Dr. Jeffrey Barkin, a psychiatrist and president of the Maine Medical Association.

Common problems include underpaid claims and a high proportion of denied claims, Barkin said. Providers recently ran into trouble because Anthem couldn’t recognize their national identification numbers. When people try to fix problems, Anthem’s customer service is hard to reach or unavailable, providers said.

The problem has led some doctors to stop accepting Anthem insurance, and the Maine Insurance Bureau is investigating the corporation’s conduct in the state.

“The Maine Medical Association would like to see a harmonious relationship between providers and payers, but this type of behavior directed at hospitals, at physicians, has no place in the health care ecosystem,” Barkin said.

In a statement Friday, Anthem said it strives to pay claims as efficiently and quickly as possible in accordance with the contracts it has with providers. Over the past year, the insurer processed 92 percent of claims within 14 days and 98 percent of claims within 30 days, said Stephanie DuBois, director of public relations for Anthem Blue Cross and Blue Shield in Maine.

Anthem has set up a dedicated Maine provider support team to deal with the issues, DuBois added. The company did not respond directly when asked if there were widespread billing problems in Maine and why the company is unable to pay Maine providers on time.

“We are proud of our progress, but these are complex issues that take time to properly address and we are committed to solving them,” DuBois said. “We have communicated our progress to Maine providers and will continue that direct dialogue as we continue to resolve these challenges.”

Maine Medical Center, the state’s largest hospital, will leave Anthem’s insurance network in January due to its payment practices, according to a Wednesday announcement from MaineHealth, the hospital’s parent organization. The breakup would mean patients with Anthem insurance would have to pay dramatically higher out-of-pocket costs for care at Maine Med, which would become an out-of-network provider.

In its announcement, MaineHealth said Anthem paid $13 million less than the Portland hospital claims and owes $70 million to the entire hospital network, which includes eight hospitals in Maine and one in New Hampshire. Anthem responded by accusing the Maine Medical Center of overbilling for anesthesia and operating room services.

WIDESPREAD BILLING PROBLEMS

These are familiar and frustrating issues for many small practices across the state. Anthem’s billing problems have affected therapists, chiropractors, opticians, ophthalmologists and others, according to professional associations.

Lev Myerowitz, a chiropractor in Cape Elizabeth, said Anthem owes him hundreds of thousands of dollars, including for COVID-19 tests provided in 2020.

“First it was a coding error, then a software billing issue. I think they have run out of excuses. It’s pretty obvious that this is a clear company-wide focus,” Myerowitz said.

“I am not the only office,” he added. “This is statewide. Small companies have absolutely zero ability to deal with big insurance. We have to choose to be in the network and accept the terms provided or not to be in the network. Leaving Anthem as a provider would be the same as not taking out insurance altogether.”

Last month, groups including the Maine chapter of the National Association of Social Workers called a meeting of about 100 providers and Anthem executives to address the issue, said Chris McLaughlin, the association’s executive director.

“To its credit, Anthem has dedicated some staff resources specifically to Maine to help resolve the challenges. For some people it felt too little, too late. Some people have made the decision to leave the Anthem network,” McLaughlin said.

LEAVING THE NETWORK IS RISKY

Leaving the network can be risky for providers and patients. The Indianapolis corporation covers 54 percent of insured Mainers and is one of the largest health insurance companies in the U.S. If doctors, therapists and others stop taking insurance, they could lose clients or force them to pay higher out-of-pocket costs.

“We don’t know the scale of the exodus,” McLaughlin said. “We hear from many social work professionals who feel compelled to accept this and deal with it on behalf of their clients so they don’t lose services.”

Professional associations banded together last year to pressure the Bureau of Insurance to open an investigation of Anthem’s operations called a market conduct review, said Bob Reed, executive director of the Maine Chiropractic Association.

The Bureau of Insurance did not answer questions Friday about its investigation of Anthem and the involvement of professional associations in furthering the investigation.

“The office is conducting a market conduct review of Anthem, which will include a review of the provider’s payment problems. The review is expected to continue for several months. At this time, Anthem has resolved most of its backlog of claims,” ​​office spokeswoman Judith Watters said this week.

Reed said all insurers have billing problems, but the problem seems much more pervasive for Anthem. It was also an issue that appears to have been simmering below the surface before MaineHealth and Maine Medical Center brought it to their attention.

“I think the Maine Medical Center IPO really opened a lot of people’s minds to what we thought was a minor issue,” Reed said. “All the doctors are going to be quiet. They think ‘it must be just me’. Situations like this make them realize that it’s not the individual doctor.”


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