Valley Health's Relationship with Anthem
Valley Health has worked in good faith for two years to quietly resolve significant payment delays with Anthem, now known as Elevance Health. Anthem, Valley health’s largest commercial insurance payor, has egregiously delayed payment for services Valley Health provided to Anthem members. Since October, when Valley Health filed suit to recoup $11.4 million in past-due payments, Anthem’s debt has continued to climb to more than $15 million.
Valley Health continues to navigate significant financial and operational challenges stemming from the lasting effects of the pandemic and rising inflation. Delayed payment from Anthem further limits the resources available to provide the care our patients expect and deserve from us.
Things to Know:
- Although Valley Health reserves the right to cancel its contract with Anthem, we have chosen not to do so. We are making every attempt possible to resolve issues with Anthem and preserve access to care for our community.
- Nothing changes for Anthem members at this time. Appointments and procedures should continue to be scheduled for patients covered by Anthem insurance. However, Valley Health’s contract with Anthem is set to expire on December 31, 2023. While we want to preserve access to care for our community, it is unlikely we will continue doing business with a company that doesn’t pay what it owes.
Frequently Asked Questions
Q. How do I know if Anthem is paying my claims?
A. If you have not received an Explanation of Benefits (EOB) form from Anthem for care you received from Valley Health, then Anthem has not paid your claim. When Anthem finally pays a patient claim, it will generate an EOB and patients can owe money months or years later. This may have implications for deductibles or out-of-pocket maximums if claims are paid years after services are rendered.
Q: Why is Valley Health suing Anthem?
A: Valley Health has experienced egregious delays in payment from Anthem, that violate the terms of our mutually agreed upon contract. Some payments are years past due. As a result, Anthem’s actions have left us no choice but to file suit to recoup millions in past-due payments owed to our health system.
Q. I have Anthem as a supplement to my Medicare coverage, will I still be covered?
A. Valley Health continues to be in network with Anthem, however should our contract not be renewed on 12/31/2023, Anthem will pay the patient portion due, as they do now, and there should be no difference in the amount paid. The only thing that may be different is that Anthem may send a check to you, rather than to Valley Health. In that case, you would simply be responsible for paying that amount to us, given that it’s the patient portion due as determined by Medicare.
Q: Why couldn’t Valley Health and Anthem resolve the issue earlier?
A: Despite working for two years in good faith to quietly resolve the payment issues we have been experiencing with Anthem, they have shown no desire to reach a fair resolution. Unfortunately, they continue to delay progress and their actions have left us no choice but to file suit and expend avoidable financial and operational resources to recoup payment for services that stretch back multiple years.
Q: Will my care at Valley Health facilities be impacted if I am covered by Anthem?
A: At this time, our patients covered by an Anthem health plan will not be impacted and may continue to visit our hospitals, facilities, and care providers as they normally do. Appointments and procedures will continue to be scheduled for patients covered by Anthem insurance through December 31, 2023.
Q: Why hasn’t Anthem reimbursed Valley Health?
A: Anthem made 6.1 billion in profits in 2021. Anthem has been egregiously behind on reimbursement to other providers across the country for many years, at a time when health care organizations like ours needed support from our insurance partners the most. While we continue to navigate significant financial and operational challenges stemming from the lasting effects of the pandemic, Anthem is further straining our resources by obstructing the dollars necessary to retain quality care providers, innovative medical technologies, and state-of-the-art care facilities, in addition to benefits we deliver to our community at-large.
Q: Is Valley Health more expensive than other health systems in the Commonwealth?
A: No. Our critics may say that Valley Health is expensive, but our costs reflect a highly complex and technical field – no different than other healthcare systems. We work diligently to maintain healthcare affordability to those we serve, including Anthem’s members, to help our patients and communities achieve their best health. Every dollar Anthem withholds impacts our ability to serve our community and fairly compensate our 6,500 employees.