Valley Health files suit to recoup millions in past due reimbursement owed by Anthem

Valley Health System filed suit in the Circuit Court of the City of Winchester today against Anthem Blue Cross Blue Shield, now known as Elevance Health. The lawsuit includes two counts: Breach of Contract and Violation of Virginia Ethics and Fairness in Carrier Business Practices Act.

For two years, Valley Health contends, it has worked in good faith to quietly resolve significant reimbursement issues with Anthem, egregious delays in payment for healthcare services delivered to its members.

“Anthem has left us no choice but to take legal action and expend resources to recoup the $11.4 million dollars in past due payments that are contractually owed to our health system, some of which are years past due,” said Valley Health President and CEO Mark Nantz.

At a time when Valley Health is navigating decades-high inflation, pandemic-related financial challenges, and ongoing losses incurred from treating Medicare, Medicaid, and self-pay patients, Anthem has announced record profits.

“We will continue to do our part to serve our community and ensure patients have access to the providers and services of our health system. But we  must hold Anthem—one of the nation’s largest health insurers and responsible for a large portion of Valley Health’s revenue—accountable for the harmful effects of their payment delays that ultimately impact our ability to sustain quality community healthcare services,” Nantz explained. “We will not accept Anthem’s continued avoidance of the payments owed to our health system, which limits our resources to deliver the care our patients and their members pay for, expect, and deserve.”

• Complaint – VHS v. Anthem
• Valley Health’s relationship with Anthem

Valley Health is a nonprofit health system serving a population of more than 500,000 in the Northern Shenandoah Valley of Virginia, the Eastern Panhandle and Potomac Highlands of West Virginia, and western Maryland. As a healthcare provider, employer, and community partner, Valley Health is committed to improving the health of the region. The system includes six hospitals, more than 70 medical practices and Urgent Care centers, outpatient rehabilitation and fitness, medical transport, long-term care, and home health.