Insurer skips doctors and sends massive checks to patients, prompting million-dollar lawsuit

Mar 1, 2019

  1. Northeast Agent
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    Insurer skips doctors and sends massive checks to patients, prompting million-dollar lawsuit - CNN

    Those allegations are part of a lawsuit winding its way through federal court that accuses Anthem and its Blue Cross entities of paying patients directly in an effort to put pressure on health care providers to join their network and to accept lower payments.

    The insurance giant is accused of sending more than $1.3 million in payments to patients -- money, the suit claims, that is owed to the facilities that treated people with addiction and mental health problems.

    The suit by Sovereign Health highlights part of an ongoing war between insurance companies and providers over payment and billing issues, one that puts the patient right in the middle of the fighting by sending payments straight to patients after they seek out-of-network care. Patients are supposed to send the money on to providers. Many times, they do; other times, they don't.
     
  2. rousemark
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    rousemark Still Here!

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    If a provider is not required to participate in a network, why should the network be required to accept an assignment to that provider.. Sounds to me like what is fair for the goose is fair for gander..
     
    Last edited: Mar 1, 2019
  3. Sofia Hurley
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    Sofia Hurley New Member

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    An Assignment of Benefits to the provider should be honored, whether they are In-Network or Non-Network if benefits are available for the services rendered. For those kind of dollars, I'm sure the providers obtained assignment. My opinion - it's the patient who gets "hurt" in these battles. Too many average people are struggling to keep every-day bills paid and when benefit monies are received, they might need to "spend" the money somewhere other than on the hospital bill. A check for several thousand dollars can be a pretty big temptation. The patient that gives into temptation and doesn't pay their hospital bill, just winds up in more financial trouble. Surely, the Insurer has policies and procedures in place to ensure they pay only a fair price for the Non-Network services so why send the money to the patient? As a provider, would you want to partner with an insurer who plays those kind of games? As an insurer, why not amend the Plan to exclude providers who charge unreasonable rates and refuse to join your network? Don't put the patients in the middle of the fight.
     
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