Bon Secours, Anthem reach agreement in $93M dispute

Bon Secours announced Friday it has reached an agreement with Anthem Blue Cross and Blue Shield in Virginia, which the health system sued in August, alleging the insurer owed Bon Secours $93 million in unpaid claims.

Although details were not released due to confidentiality agreements between the two parties, Bon Secours said it will drop the lawsuit, which was filed in Henrico County Circuit Court, and all Anthem Medicare Advantage and Medicaid health plan members will again have in-network coverage at Bon Secours. The agreement also extends coverage for employer-based Anthem customers and Affordable Care Act plan members until 2028.

“I’m proud that both organizations continued to focus on our shared priority: the communities we serve,” Anthem Virginia President Monica Schmude said in a statement. “We worked together to creatively address affordability for our members and the financial needs of an important care provider. This agreement provides long-term stable access to care at Bon Secours without cost increases for our members and employers.”

Anthem agreed to cover any claims that Medicare patients incurred at Bon Secours facilities since Aug. 1, when the health system was out of network.

“We understand that being out of network/potentially being out of network can be very difficult, and we are pleased that patients with Anthem insurance can now see our physicians and use our hospitals at an in-network cost,” Mike Lutes, president of Bon Secours Richmond, said in a statement. “We sincerely believe that access to quality health care services is vital for our communities. This new agreement protects our patients’ access to compassionate care close to home.”

The agreement also prevented Bon Secours from being out of network for Medicaid patients, which would have occurred Oct. 1 absent a deal.

In April, Winchester-based Valley Health and Anthem  settled a $15 million lawsuit filed by Valley Health over unpaid reimbursements. The terms of that settlement also were confidential.

On June 28, Anthem paid $300,000 to settle a finding from the State Corporation Commission’s Bureau of Insurance that it was not paying claims within the 40-day requirement. State regulators found that Anthem did not pay 347 claims of the 67,000 it received from December 2022 to February 2023 within the 40-day timeframe.

Bon Secours has 10 hospitals in the Richmond area and Hampton Roads and has more than 14,000 employees, including 820 physicians, according to the complaint.

Anthem, owned by Elevance Health, is the largest health insurance carrier in Virginia. Elevance reported $156 billion in total revenue for 2022, with net income of $6 billion.