UnitedHealthcare, Anthem behind on billions of payments to hospitals

The country's two largest insurers — UnitedHealthcare and Anthem — are behind on billions of dollars of payments to hospitals due to new reimbursement rules, claims issues and retroactive claims denials, according to a Kaiser Health News article republished in USA Today

For instance, Richmond-based Virginia Commonwealth University Health alleged Anthem owes the provider $385 million, according to the Oct. 5 article. Over 40 percent of payments are more than 90 days old, violating state law dictating that insurers must pay claims within 40 days. 

The American Hospital Association told reporters that complaints span across the country. Between June 30, 2019, and June 30, 2021, Anthem's unpaid claims rose from 43 percent to 53 percent, accounting for $2.5 billion. 

UnitedHealth's unpaid claims have remained at 54 percent over the past two years, according to the report. 

Anthem delays payments through new paperwork, requirements for prior authorization or requests to speak with doctors directly, according to the report. It also creates hurdles that encourage patients to use facilities it owns. 

Anthem said many of these steps are taken to control excessive prices from hospitals. 

Patients complained that UnitedHealthcare denied payments due to a lack of documentation of medical necessity or delayed payments due to prior authorization system outages, according to the report.

The insurer told reporters that facilities may appeal claims decisions and that the July prior authorization downage was "resolved quickly."

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