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Insurer skips doctors and sends massive checks to patients, prompting million dollar lawsuit
A woman received nearly $375,000 from her insurance company over several months of treatment she received at a California rehabilitation facility. A man received more than $130,000 after he sent his fiancée’s daughter for substance abuse treatment.
Those are allegations against Anthem and its Blue Cross entities for sending more than $1.3 million in payments to patients. Money, the suit claims, that is owed to the facilities that treated people with addiction and mental health problems.
The suit by Sovereign Health highlights parts of an ongoing war between insurance companies and providers over payment and billing issues, putting the patients in the middle of the fighting, sending payments straight to patients after they seek out-of-network care. Patients are supposed to send the money on to providers. Many times, they do; other times, they don’t.
Critics say it’s a revenge tactics against the doctors, hospitals, treatment facilities and other medical providers that don’t agree to Insurance companies’ demands to be “in-network,” by making them chase down money. The insurance industry disputes any such characterization.