Valley Health CEO Mark Nantz said Thursday that Valley Health has filed a lawsuit against Anthem for unpaid restitution of $15 million.
The federal case will likely continue through 2024, which Nantz said is bad news for Anthem members because Valley Health’s contract with Anthem expires on December 31, 2023.
“We believe it is important to convey the message to the community beforehand,” he said, “that the relationship is not in good shape, we are in serious disagreement with each other … and we have a contract that [will expire],
Not doing business with Anthem means that all Valley Health patients who use Anthem as their insurance carrier for state or federal plans or Medicare or Medicaid will be excluded from receiving care at Valley Health facilities. Off-network cost will have to be paid, which includes the area. Hospitals, urgent care centers and doctor’s offices that use the Valley Health name.
If Valley Health does not renew its contract with Anthem, it would affect more than 56,000 area patients, including federal or state employees or those who use Medicare or Medicaid. This number does not include private employers that contract with Anthem for employee health insurance.
Valley Health, which operates facilities in the counties of Winchester and Clark, Frederick, Page, Shenandoah and Warren, as well as the West Virginia counties of Hampshire and Berkeley, Winchester Medical Center, Shenandoah Memorial Hospital, Warren Memorial Hospital, Page Memorial Hospital , Hampshire Memorial Hospital and War Memorial Hospital in Berkeley Springs.
Although Valley Health’s contract with Anthem runs through the end of the year, Nantz said open enrollment begins in late summer, and only then will insurance customers need to know which insurance plans they intend to pursue. Let’s keep
“It’s like the current situation,” Nantz said. “The difficult thing is that the people in the middle are the patients.”
If Valley Health and Anthem do not come to an agreement by late summer, he said they likely will not renew their agreement with Anthem.
“And those who choose Anthem will be out of network with Valley Health,” he said.
“The public really has an opportunity to look at other insurance,” Nantz said. “And businesses in the community have the opportunity to look at other health plans before the end of our contract with Anthem.”
In October, the health system announced it was suing Anthem for $11.4 million “in past due payments that are contracted to our health system, some of which are owed from previous years.”
Now that amount has grown to about $15 million, Nantz said.
“We tried for two years with Anthem to try to resolve the matter in a commercially reasonable way,” he added. “We’re not really going anywhere.”
Gann recently requested that the case go to federal court, and Nantz said Valley Health “didn’t make that argument.”
Although Nantz said that Valley Health has not decided whether to renew its contract with Anthem after this year, it is unlikely that they will do so given the $15 million in unpaid costs with the insurance provider. There is a trial going on for more than
“At this point nobody thinks it makes sense to contract with someone who isn’t paying you,” he said. “It doesn’t sound like good business to us.”
Making matters worse, he said Valley Health is paying more for employment and services during the COVID-19 pandemic.
“In the labor sector, our cost has gone up by about 30 per cent,” he said.
On Tuesday, the health care system announced it would close its fitness centers in Woodstock, Front Royal and Berkeley Springs, West Virginia, through February 1, citing “unprecedented financial challenges related to the impact of the pandemic and its aftereffects.” has been cited.
Because Valley Health is a nonprofit entity, Nantz said they don’t have much money to get them through the tough times beyond savings, which have been dwindling due to the pandemic.
“The public needs to understand that we are not serving the shareholders, we are serving the community,” Nantz said.
“Our mission hasn’t changed,” he said. ,[Valley Health] is a community property. Every penny we make goes back into the community.”
According to a document from Valley Health, Anthem is projected to make $6.1 billion in profit in 2021 alone, up nearly 30% from 2020.
“I think it’s important that people understand that Anthem is in business to make a profit,” Nantz said.
The chances of resolving it through the court system, he said, “I think will be zero. The only way to resolve this is through dialogue and coming to the table.”
This isn’t the first time Valley Health has come close to breaking ties with Anthem. In 2020, Valley Health threatened to end its partnership with Anthem in protracted negotiations over reimbursement, but the two eventually reached terms.