Seven hospitals affiliated with Nashville, Tenn.-based HCA Healthcare filed a lawsuit Oct. 5 against Anthem Blue Cross and Blue Shield in Georgia, part of Elevance Health, alleging denied or underpaid claims, according to court records reviewed by Becker’s.
Corpus Christi Medical Center, HCA Houston Healthcare North Cypress, Lone Peak Hospital, TriStar Skyline Medical Center, Belton Regional Medical Center, Mission Hospital and Overland Park Regional Medical Center filed the lawsuit in a Georgia federal court. The complaint said the hospitals are entitled to at least $501,213 in reimbursement for eight of the insurer’s members.
Several denied authorizations stemmed from a purported lack of medical necessity, the lawsuit said. Some billed services were emergency and post-stabilization care services, which the complaint said Anthem would be obligated to pay under state and federal laws. Some claims and appeals were also rejected as duplicates or for missing information, according to the complaint.
The hospitals span six states: Texas, Utah, Tennessee, Missouri, North Carolina and Kansas. The lawsuit argued the hospitals’ contracts with local Blues plans extend to out-of-state Blues plans, such as Anthem, that tap into the negotiated rates through the BlueCard program, putting Anthem on the hook for paying claims at those rates.
The hospitals are seeking the enforcement of agreements or an implied-in-fact contract, as well as an award of the $501,213, plus other damages.
Becker’s has reached out to Anthem for comment and will update this story if more information becomes available.
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