San Clemente, Calif.-based Sovereign Health is suing Anthem and its Blue Cross entities for sending more than $1.3 million in payments to patients that is allegedly owed to facilities that treated them, according to CNN.
Three things to know:
1. The lawsuit alleges Anthem is sending payments directly to patients after they seek out-of-network care to pressure providers into joining its network and accepting lower reimbursement, according to the report.
2. The patients are supposed to send the money to providers, but some patients don't. Arthur Caplan, PhD, director of medical ethics for New York University's School of Medicine, told CNN it's "insane" to send reimbursement directly to patients. "I'm enormously surprised that anyone would think this is a doable approach," he said.
3. In court filings, Anthem does not dispute that checks are given to patients in some cases for out-of-network care. The insurer argues Sovereign Health's lawsuit should be dismissed for lack of legal standing. The insurer also argues previous court decisions determined anti-assignment clauses that allow for payments to patients are legal, according to CNN.
Access the full CNN article here.
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