A pair of insurers have yet to pay their bills, and we aren’t talking chump change.
Provider representatives say the insurers are billions of dollars behind on payments owed to hospitals and doctors. Which insurers? Per the article, the delinquent duo is none other than our country’s two largest health insurers: Anthem Blue Cross and UnitedHealthcare.
One health system in particular – Virginia Commonwealth University Health – reports that Anthem is behind nearly $385 million in payments and is now in violation of state prompt payment laws.
But this is not just a Virginia problem, says Rick Pollack, CEO of the American Hospital Association. He told USA Today that “complaints about Anthem extend ‘from sea to shining sea, from New Hampshire to California.’”
Maybe United and Anthem need a refresher, and we’re happy to provide one. Here’s how the system is supposed to work:
- Patients pay premiums to insurance companies for health.
- Insurance companies contract with hospitals and agree to cover the services provided to said patients.
- Hospitals and doctors provide said services to said patients and then bill the insurance company, per the mutually agreed-upon contract.
- Insurance companies hold up their end of the deal and pay what they owe.
It really isn’t that complicated. You sign a contract, you get a bill, you pay a bill. And yet, it’s just not happening. The reasons are endless—that service isn’t covered. That hospital isn’t in-network. That service is covered and the hospital’s in-network, but that doctor isn’t.
Basically, patients either can’t get the care they need, or they wind up having to pay way more than they should, and the insurers still seem determined not to pay what they owe.
Anthem’s financial reports, at least, seem to back up doctors’ complaints. In the second quarter of 2019, before the pandemic, unpaid claims made up 43 percent of medical bills for the insurer. By the second quarter of this year, unpaid claims hit 53 percent—up by 10 percent.
Just imagine if this was anybody else, in any other industry. Say, government student loans refusing to pay for education because students didn’t get their classes pre-authorized. Or manufacturers refusing to pay for supplies they use. Or a restaurant patron dining and dashing.
Everywhere else, it just doesn’t fly. So why do health insurers keep getting away with it?
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