46
HEALTHCARE
NEWS
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UnitedHealthcare, Anthem behind on billions of
dollars in payments to hospitals
By Nick Moran
T
he country's two largest insurers —
UnitedHealthcare and Anthem — are
behind on billions of dollars in pay-
ments to hospitals due to new reimburse-
ment 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.
e 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, ac-
cording to the report.
Anthem delays payments through new
paperwork, requirements for prior autho-
rization or requests to speak with doctors
directly, according to the report. It also cre-
ates 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 docu-
mentation of medical necessity or delayed
payments due to prior authorization system
outages, according to the report.
e insurer told reporters that facilities may
appeal claims decisions and that the July
prior authorization downage was "resolved
quickly."
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