Doctors group files complaint against Anthem-WEB ONLY

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The Indiana State Medical Association has filed a formal complaint against Anthem Blue Cross and Blue Shield of Indiana for ongoing claims-payment issues.

The doctors group, in an announcement today, contends that computer problems at Anthem have yet to be resolved, breaching a 2005 court settlement reached by doctors and Anthem’s parent company, Indianapolis-based WellPoint Inc.

The complaint was filed July 9 with the dispute facilitator appointed as part of that settlement, Connecticut attorney Cameron Staples. Samples has put the dispute into mediation, according to an ISMA spokeswoman.

“The ISMA is still receiving complaints indicating a number of issues remain unresolved and some new problems with Anthem have now appeared,” Julie Reed, legal counsel for the Indiana State Medical Association, said in a statement. “It’s time for all these problems to come to an end.”

The medical association statement says the Indiana Department of Insurance has received more than 1,500 complaints against Anthem in the past two-and-a-half years. The number of complaints in 2008 surged 54 percent.

The association also details complaints from its members. One specialty medical office was owed more than $175,000 by Anthem for 860 claims, the association claims. The practice had transmitted the claims electronically two or three times and received confirmation from Anthem of the transmissions. But Anthem representatives reported the claims had not been received and could not be paid because the timely filing deadline had passed.

The doctors’ complaints comes on top of a lawsuit filed in November by Mishawaka-based Sisters of St. Francis Health Services, which accused Anthem of breaching its payment contract with the hospital system by failing to timely pay claims.

An Anthem spokesman could not immediately be reached for comment.

In the past, Anthem officials have emphasized that the problems only affected 13 percent of its Indiana patients – those working for large national employers who participate in a nationwide program called BlueCard.

In 2005, WellPoint establish a $135 million fund to compensate 700,000 physicians who said they were underpaid for treating patients.

Doctors had accused WellPoint and other U.S. insurers of creating processing software that automatically “downcoded” claims submitted by physicians to reduce the reimbursement rate.

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