A current lawsuit is 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 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. Critics say it’s a revenge tactic against doctors, hospitals, treatment facilities and other medical providers that don’t agree to insurance companies’ demands to be “in-network,” by making them chase down money. (from Crains Chicago Business, February 2019)
Barbara L. McAneny, president of the American Medical Association, blasted what she called insurance “bully tactics” that seek to force physicians to go “in-network” — tactics that she said have become more widespread as insurance companies have grown in size and power. She said many health insurers ignore “assignment of benefits” agreements between patients and physicians, deciding to send payments straight to patients. “The reality is that insurers refuse to recognize these agreements to create a market advantage for themselves against physicians who do not participate in the insurer’s network.”
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