1/28/2024 0 Comments Anthem health insuranceTransparency rules that took effect in 2022 “were supposed to essentially fix this problem,” Gordon said. “It’s sort of a fine line, because if you are self-insuring your coverage,” she said, “you have this financial obligation to pay those claims.” Third-party administrators typically claim the information is proprietary and they aren’t willing to share it with the plan sponsor, Amy Gordon, a partner with Winston & Strawn LLP in Chicago, said in an interview. Anthem did not return a request for comment. The law firm handling the case for Owens & Minor said neither it nor the company would comment on the case on the record. “Those are the things that are going to take a $10 million group down to an $8 million group” in terms of health-care spending by plans, he said. “If we go through this fiduciary process, and we understand where our claim dollars are being spent-that there’s waste, there’s abuse, there’s misadjudication of claims-we’re going to be able to save a lot of money,” Sorrentino said. “We finally have a plan sponsor with the guts to do this,” Tony Sorrentino, a lawyer who is president of Health Plan Fiduciary Compliance LLC, a health-care compliance consulting firm based in Parker, Colo., said in an interview. Owens & Minor is a Fortune 500 company that employs over 17,000 people in 70 countries and is headquartered in Richmond, Va. Owens & Minor is asking the court to provide injunctive relief by requiring Anthem to give them access to their data. 13, cites recent reports of “instances where opportunistic claims administrators have employed illegal or unethical means to obtain windfall profits-at the expense of self-funded plans and taxpayers alike,” including accusations that Anthem affiliates gave incentives to health-care providers to report that Medicare Advantage patients are sicker than they actually are because insurers received more income for patients with more serious documented conditions. Health plans are entitled to analyze their claims data to determine whether fiduciary duties to operate the plan in the best interest of beneficiaries are being met, and plan administrators shouldn’t interfere with those duties by withholding claims data based on the “erroneous” assertion that the data is the administrator’s “proprietary” and “confidential” information, the suit said. “This case is important to plaintiff and self-funded plans in general,” Owens & Minor said in its complaint. 116-260), which requires employer-sponsored health plans to have access to their own data. Employers are now aided in that effort by the Consolidated Appropriations Act of 2021 ( Public Law No. The case is the latest filed by employers demanding claims data so that they can perform their fiduciary duties in assessing whether payments for health services are correct and reasonable. Owens & Minor’s health plan is self-funded and regulated under the federal Employee Retirement Income Security Act. said Anthem Health Plans of Virginia Inc., which does business as Anthem Blue Cross and Blue Shield, repeatedly refused to turn over claims data requested since 2021. In a lawsuit filed in US District Court for the Eastern District of Virginia, medical supply logistics company Owens & Minor Inc. A lawsuit filed by an employer health plan against its health insurance administrator may open the door for other employers to demand access to their medical claims data, health-care consultants say.
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