Bon Secours sues Anthem BCBS for $93M, alleging unpaid claims

Cincinnati-based Bon Secours Mercy Health is suing Anthem Blue Cross Blue Shield of Virginia for $93 million, alleging the payer owes the health system millions in unpaid claims, according to a lawsuit filed in a Virginia circuit court.

Anthem Blue Cross Blue Shield of Virginia is a subsidiary of Elevance Health, which operates 14 for-profit BCBS subsidiaries. 

Jordan Vidor, vice president of provider networks for Elevance's east region, told Becker's the lawsuit was made public before the payer had been served with it. 

"The decision by Bon Secours to leak a copy of the filed lawsuit to the press is exactly what it appears to be: an attempt to distract from what they have done and a tactic to garner a headline," he said.

On Aug. 28, Bon Secours filed suit against Anthem Blue Cross Blue Shield of Virginia in Henrico County Circuit court, according to court documents shared with Becker's. The health system is alleging Anthem owes BSMH $73 million in unpaid claims dating back to 2019. The system said it also lost an additional $20 million in revenue from claims denial adjustments and write-offs. 

"The lawsuit itself is factually baseless," Mr. Vidor said. "If Bon Secours believes they have been underpaid, we encourage them to file the appropriate appeals and disputes processes that we make available to them, which they have failed to do."

The lawsuit comes in the midst of a dispute over reimbursement rates between the two organizations. BSMH wrote on its website, "By failing to reach an equitable agreement with us, Anthem may be putting your in-network access to the Bon Secours facilities and providers you know and trust at risk." 

A spokesperson for the health system previously told Becker's it is seeking higher reimbursement rates from all Anthem plans it contracts with besides Medicaid.

Since Aug. 1, nearly 50,000 Anthem Medicaid beneficiaries in Ohio and 11,000 Anthem Medicare Advantage members in Virginia have been out of network with Bon Secours Mercy facilities. Anthem's Medicaid plan in Virginia and Medicare Advantage members in Ohio and Kentucky will be out of network with a majority of BSMH facilities by October. 

On Aug. 22, Anthem filed a cease and desist order against BSMH, alleging the system was improperly denying access to care to Anthem Medicaid beneficiaries in Virginia — Elevance told Becker's Sept. 1 that all incorrect denials of care have since been resolved. Elevance also alleges its internal investigative unit found that Bon Secours overbilled the payer for emergency room services. 

Both organizations told Becker's they have attempted to arrange meetings between executives to discuss the issue, but no contract agreement has been reached.

Editor's note: This article was updated Sept. 6 to reflect additional comments from Elevance Health.

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