Carbon Health airs dispute with Anthem Blue Cross

Hybrid primary care company Carbon Health is airing a dispute with Anthem Blue Cross of California, alleging the payer has denied all out-of-network claims for services provided to members.

Carbon Health's in-network contract with Anthem Blue Cross, a subsidiary of Elevance Health, ended March 17 after talks between the two parties over reimbursement rates broke down. Carbon Health said in an April 29 blog post it had been trying to "negotiate a livable wage and reduce the administrative burden for the services our care teams work hard to provide."

"Even a meaningful increase to our reimbursement rates would not have brought us anywhere close to what Anthem currently pays other urgent care and primary care providers in California," Carbon Health wrote.

An Elevance Health spokesperson told Becker's that Carbon Health "terminated its contract" after continuing to "insist on excessive rate increases, which would result in higher costs for the people and businesses we serve."

Since the contract termination, Carbon Health said Anthem has stopped processing thousands of out-of-network claims and that it plans to resubmit them in the hopes Anthem will reconsider. If Anthem continues to deny the claims, Carbon Health said patients will be charged no more than the "standard self-pay cash price."

Elevance Health also disputed the assertion that it is not processing the claims. "As a normal course of business, Anthem routinely processes out-of-network claims as many of our members do have out-of-network coverage as part of their benefits plan," the spokesperson said. "However, we strongly encourage our members to seek healthcare services from one of the many care providers in our network."

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars