Hospitals Challenge Anthem Blue Cross Over Member Direct Pay
A number of hospitals are criticizing Anthem Blue Cross and other health insurers for sending checks for medical services directly to members who undergo treatment at out-of-network facilities, the Los Angeles Daily Journal reports.
The practice, called "member direct pay," is becoming more common as hospitals terminate their contracts with Anthem Blue Cross.Â
Critics maintain that the practice lets Anthem Blue Cross independently determine what it will pay for services at out-of-network facilities and puts the burden on hospitals to collect the funds from the patients.Â
Scope of the Situation
At least nine hospitals contacted by the Daily Journal said they were aware of Anthem Blue Cross sending checks directly to patients instead of hospitals.
Industry insiders say that Blue Shield of California also has sent checks directly to patients but not to the same extent as Anthem Blue Cross.
Anthem Blue Cross officials defended the policy but said they were reviewing it. The insurer declined to comment on the issue in detail.
Some states have banned the practice, but California regulators have not yet weighed in (George, Los Angeles Daily Journal, 4/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.