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One of California’s largest health insurance plans has distinguished itself, and not in a good way.

The state Department of Managed Health Care hit Anthem Blue Cross with $9.6 million in fines from January 2014 through early November 2019, according to a California Healthline analysis of agency data. That is about 44% of the $21.7 million in penalties the department issued against full-service health plans during that period.

And yet, Anthem covered only 10% to 13% of Californians with department-regulated plans. An annual average of 3.8 million Californians wer...

Anthem Blue Cross filed a lawsuit against the federal government to recoup $100 million in payments under the ACA, according to Bloomberg Law.

In the Nov. 18 lawsuit filed in the U.S. Court of Federal Claims, Anthem argued it sold plans on the ACA individual exchange because the government said it would offset expected losses on the policies through the risk corridors program. 

Risk corridors payments, which expired in 2016, aimed to protect insurers from large deficits as they enrolled sicker members into their new individual exchange policies. While the program int...

When a patient sees a provider, the patient signs an “assignment of benefits” contract with the provider, assigning the patient’s legal rights to recover benefits from the insurance company to the provider so that the provider can be directly reimbursed for the services rendered to the patient. When the provider is in-network, this process is executed with little fanfare. However, for an out-of network provider, the road to reimbursement is not always as smooth. Not all states expressly permit assignment-of-benefits clauses, and as a result, insurers send the reimb...

Emergency Department physicians being out of network is nothing new, but a new round of failed negotiations between a local emergency physician group and Blue Cross Blue Shield of Texas have both sides crying foul and pointing fingers.

Blue Cross Blue Shield contacted members to describe how Texas Medicine Resources, a physician group hired by Texas Health Resources emergency rooms, has terminated its deal with BCBSTX, meaning the group is now out of network at 14 area hospitals for its Blue Choice PPO and Blue Essentials HMO members.

A statement on BCBSTX’s “St...

Cigna Corp. officials did everything they could to sabotage a $48.9 billion merger with Anthem Inc., including refusing to consider divestitures that would have helped the deal win regulatory approval, Anthem’s general counsel told a judge.

Cigna refused to turn over data Anthem executives needed to convince U.S. Justice Department attorneys of the merger’s value to customers, Thomas Zielinski, Anthem’s top lawyer, testified Monday in the opening of a damages trial tied to the transaction’s collapse.

After Cigna Chief Executive Officer David Cordani expressed unhappi...

A politically charged lawsuit that originally would have pitted seven independent New Jersey hospitals against the state’s largest health insurance company has ended. Less than two hours before oral arguments were to begin in a Hackensack courtroom, The Valley Hospital, the last remaining plaintiff in the case, agreed to withdraw its claim that Horizon Blue Cross Blue Shield of New Jersey’s OMNIA health plans violated the spirit of its contract with the hospital. Horizon said in a statement it was “pleased to have reached an agreement with Valley Health System. We...

CentraState Medical Center in Freehold Thursday became the latest hospital to drop a three-year-old lawsuit against Horizon Blue Cross Blue Shield of New Jersey that accused the state's dominant health insurance provider of squeezing community hospitals out of the market.

CentraState was once one of seven hospitals that sued Horizon for relegating them to a more expensive tier in the company's OMNIA discount health plans, which Horizon said would revolutionize health care options in the state.

Valley Hospital in Ridgewood, the last plaintiff in the case, an...

The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) today filed suit against Anthem's Blue Cross Blue Shield of Georgia in federal court in an effort to compel the insurance giant to rescind its controversial and dangerous emergency care policy that retroactively denies coverage for emergency patients. To read the lawsuit, click here.

Over the past year, Anthem implemented its policy in Georgia and five other states, leaving patients who sought emergency care responsible for paying their entire bills if the insurance comp...

A controversial policy instituted by Blue Cross Blue Shield of Georgia and parent company Anthem Insurance Cos. denying emergency room claims after the fact faces a legal challenge by two physicians organizations.

The American College of Emergency Physicians and the Medical Association of Georgia have asked a federal judge in Atlanta to compel Blue Cross Blue Shield and Anthem to abandon the policy, which the insurers have also implemented in Missouri, Kentucky, Indiana, New Hampshire and Ohio.

The policy, which the insurers announced last year, allows the companies...

Cliffside Park, N.J.-based Surgery Center of Cliffside alleges Horizon Blue Cross Blue Shield of New Jersey underpaid the center for a lesion procedure by $58,120.40, court documents show.

Here's what you should know:

1. Surgery Center of Cliffside filed a lawsuit against Horizon Blue Cross Blue Shield of New Jersey and Empire Blue Cross Blue Shield July 3. Empire is a licensee of BCBS.

2. The ASC performed surgery on a patient insured by Empire who had a painful, rapidly growing lesion on the side of her face.

3. In January, prior to the procedure, an Empire represent...

CMS will not make $10.4 billion in payments that were due to insurers under the ACA. 

Here's what you should know:

1. The payments were required under the ACA's "risk adjustment program" to offset costs for insurers whose customers need expensive medical services. They were due to insurers in the fall for expenses from 2017.

2. CMS Administrator Seema Verma said the suspension is based on a legal dispute over the formula used to calculate risk adjustment payments. About three years ago, a New Mexico federal court ruled the formula was flawed, but a Massachusetts judge...

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