Mercy Health Takes Dispute with Anthem to Virginia Court

YOUNGSTOWN, Ohio – Alleged unpaid and underpaid claims totaling $93 million in Virginia have led to a lawsuit in the ongoing dispute between Bon Secours Mercy Health and Anthem, also known as Elevance Health.

The civil suit was filed Monday against Anthem Health Plans of Virginia in the Circuit Court of Henrico County, Virginia, according to Mercy Health spokeswoman Kara Franz.

Bon Secours Mercy Health has announced the lawsuit and has pointed to money it believes Anthem owes as one of the reasons for attempting to renegotiate Medicare and Medicaid contracts, which have affected those with Anthem coverage locally.

The lawsuit claims Anthem is not paying bills in a timely manner, with the number of bills more than 90 days overdue growing. The normal payment time frame in the agreement is reportedly between 30 and 60 days. Additionally, the lawsuit claims Anthem has increased by 50% the number of requests for medical records each month and has increased by 21% the number of claims denied since March 2023.

Other factors claimed included a 9.6% increase in labor costs and a 6.8% increase in operating expenses and overall cost in 2022 from 2021.

According to Franz, the same situation of no pay and slow pay is also happening in Ohio and Kentucky.

It was announced previously that as of July 1, Bon Secours Mercy Health, which operates three hospitals and several satellite facilities in the Mahoning Valley, was no longer accepting Anthem Medicaid members as having in-network coverage at the local Ohio facilities.

Then in August, Mercy announced that as of Oct. 1, local Medicare Advantage patients through Anthem would also be out-of-network unless an agreement could be reached.

The insurance agency has claimed it did not leave the negotiating table and Mercy was responsible for choosing to cut off the services for vulnerable patients.

Mercy has accused Anthem of retaliatory actions and of generating more than $150 billion in annual revenues, posting a $7.8 billion profit in 2022, while Mercy Health has reported an overall loss of $1.2 billion.

Published by The Business Journal, Youngstown, Ohio.