Anthem has been served with a breach notice from Greene County General Hospital in Linton, Ind., tied to alleged payment failures nearing $1 million.
The hospital said Anthem paid claims below contract requirements and processed regular commercial claims under the wrong framework, according to an April 14 hospital news release.
Greene County General Hospital said the alleged misprocessing reduced hospital reimbursement and likely affected patient financial responsibility. The hospital said the issue has contributed to ongoing operating losses and strained its ability to sustain services.
CEO Brenda Reetz told Becker’s the error has been going on for years but the hospital began working with Anthem on several underpayment issues in September, when the hospital became aware of the issue. She said Anthem has acknowledged a specific error on hundreds of claims that have resulted in close to $1 million in underpayments but has not made any corrected payments or process changes.
“It is hard to quantify the total impact of the underpayments by Anthem because we have only begun to scratch the surface of the problem,” Ms. Reetz said.
“Anthem has acknowledged that claims were not handled correctly, yet the problem remains unresolved,” Ms. Reetz said in the release. “This has harmed our hospital, likely harmed our patients, and continues to put pressure on our operations.”
Greene County General operates a 25-bed hospital, emergency room and four clinic locations.
The hospital is calling on Anthem to identify affected claims, reprocess and pay them correctly and address broader contractual issues, according to the release.
Anthem said in an April 14 statement shared with Becker’s that it is disappointed in the hospital’s decision to serve them with a breach notice as it is already addressing the issue.
“GCGH became aware of the problem only after we identified it and notified the hospital in late February,” an Anthem spokesperson said. “We work closely with care providers to quickly resolve claims processing issues, and we will continue doing so in this case.”
The issues outlined by the hospital reflect broader trends across the state, according to an April 14 statement from the Indiana Hospital Association that was shared with Becker’s. The association said Indiana hospitals delivered more than $717 million in care that went unpaid as a result of claim denials, delayed payments and insurer practices after care was delivered, including claims that were processed incorrectly across multiple insurance organizations, according to claims data from 70 Indiana hospitals.
“What we are seeing at Greene County General Hospital is not an outlier — it is one example of a much larger, systemic problem documented across Indiana,” said IHA President Scott Tittle. “Our data shows hospitals are delivering care but not being reliably paid by insurers, often because claims are delayed, denied, or processed incorrectly even when the care is contractually covered.”
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