Anthem won't have to face a lawsuit for now that alleges the payer under-reimbursed Tampa, Fla.-based air ambulance company Jet ICU for providing out-of-network services to a beneficiary.
A U.S. district judge for the Middle District of Florida Tampa Division ruled March 17 that Jet ICU will have more time to amend their original 2021 complaint against the payer.
Jet ICU transported an Anthem beneficiary to a hospital from a cruise ship in 2019. Despite no contract between Jet ICU and Anthem, the payer approved the emergency service.
Jet ICU submitted a $414,597 claim to Anthem for the emergency services, but Anthem only paid Jet ICU about $25,675.
Anthem argued that Jet ICU did not have permission to transfer the beneficiary's coverage to its company. Anthem's coverage also does not allow claims to be assigned to a third party. Further, Anthem argues that Jet ICU does not have standing to sue under the Employee Retirement Income Security Act because it is not a participant or a beneficiary.
Jet ICU is looking to recover the unreimbursed funds and statutory interest through the suit. The company has "one final opportunity" to prove standing within 14 days.