Valley Health has filed a lawsuit against Anthem Health Plans of Virginia, alleging the payer owes the Winchester, Va.-based health system $11.4 million in past-due reimbursements, according to a statement and court documents Valley Health shared with Becker's.
In the statement, Valley Health said it had "quietly" worked to resolve billing disputes with Anthem Blue Cross and Blue Shield for two years.
"Anthem has left us no choice but to take legal action and expend resources to recoup the $11.4 million in past due payments that are contractually owed to our health system, some of which are years past due," Valley Health President and CEO Mark Nantz said.
According to court documents shared with Becker's, Valley Health first told Anthem it was not fully reimbursing claims in March of 2020. Anthem and Valley Health had regular phone calls and meetings about reimbursements through March of 2022, when Valley Health proposed mediation.
"[Valley Health] often found itself in the frustrating position of answering an endless series of burdensome (and unnecessary) requests for information, none of which was apparently ever enough to satisfy Anthem," the hospital alleged in court documents.
A spokesperson for Elevance Health, Anthem Health Plans of Virginia's parent company, said the company believes some of Valley Health's claims are inflated based on inaccurate data.
"It is a standard industry practice to review claims for medical services to ensure they are coded and billed appropriately," the spokesperson told Becker's. "Anthem Blue Cross and Blue Shield in Virginia strives to process claims as quickly as possible and in accordance with our agreements, while also verifying billing accuracy, which requires the cooperation of our provider partners."
Valley Health has not terminated its contract with Anthem because of potential disruption to the community, according to the court documents.
Anthem Blue Cross and Blue Shield members can continue to receive care at Valley Health, the spokesperson said.
"Anthem Blue Cross and Blue Shield and Valley Health have a long history of collaboration and serving communities in northern Virginia, and we will continue to approach our work together with the best interest of our members as our top priority," the spokesperson said.