• July 28, 2021

Stanford alleges Anthem owes $1.9 millon underneath implied contract

Apr 20, 2021

Stanford Well being Care sued Anthem in federal court docket on Friday, alleging the insurer’s failure to pay almost $2 million owed underneath a nationwide, reciprocal claims community violates an implied contract between the 2.

The not-for-profit well being system claimed its physicians cared for six sufferers insured underneath Blue Cross and Blue Protect of Indiana plans from 2018 to 2020, however they nonetheless have not obtained full reimbursement for his or her “traditional and customary” charges. Anthem operates Blue Cross and Blue Protect plans in 14 states, together with Indiana.

As a result of sufferers had been lined underneath an Anthem affiliate, the go well with mentioned that Anthem Blue Cross is answerable for the price of their care underneath its BlueCard program, which permits members to obtain care whereas touring or dwelling in one other plan’s service space. The criticism mentioned that Anthem receives discounted charges for providers offered by Stanford physicians by this program.

The six people’ payments mounted to greater than $2 million, in line with the criticism. Thus far, Blue Cross and Blue Protect of Indiana has paid solely $78,771 for these people’ care, leaving Stanford within the crimson for greater than $294,000 after the “written contract” low cost is utilized, the go well with mentioned.

If the court docket court docket decides that the contract is legally enforceable, the Palo Alto, Calif. well being system is searching for reimbursement for $215,000 plus curiosity or, “ought to it’s discovered no contractual relationship exists,” Stanford is requesting $1.9 million in charges for these sufferers’ care. In both case, Stanford can also be searching for to be reimbursed for the prices of submitting the go well with and some other reduction the court docket grants.

The claims mirror a criticism that Stanford Well being Care filed in opposition to Blue Cross Arkansas in January, alleging the insurer dodged paying greater than $100,000 due for affected person’s care underneath the BlueCard program. Attorneys for the Arkansas Blue Cross affiliate filed to a movement to dismiss the case on April 15, saying that the lawsuit exceeded the statute of limitations, Blue Cross didn’t request the care offered and that Anthem by no means contacted the insurer in regards to the claims.

Stanford and Anthem didn’t reply to interview requests.

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