‘My practice is in jeopardy of closing:’ Counselor waiting for payments from Anthem

HENRICO, Va. (WWBT) – A counselor in Henrico County is fighting to keep her practice open after months of insurance claims getting denied from Anthem.

Anita Stoudmire is a licensed professional counselor and owner of G.R.OW.T.H. Therapy Center. She started the private practice in 2019.

“We provide services. I have the claim process through my biller. She does that through my electronic health record platform and I produce a note. Each person has a treatment plan, but my biller is the one who pushes those claims to Anthem, and we’re told that it takes about 4 to 6 weeks to process claims,” she explained.

Stoudmire says her practice was used to getting a check every week or so from the insurance company. She says issues started in the fall of 2022 after informing Anthem she would end her contract, effective Feb. 1, 2023. Stoudmire started getting letters stating her address, tax ID or provider identifier number was wrong, and the claims were being denied.

“In September of 2022, it was my intention to discontinue my contract with Anthem because I wanted to become a direct pay practice, and that’s when the problems began. Once I put in the application that I want to not renew my contract with Anthem, that’s when my claims stopped getting processed,” she said.

She was told in a Feb. 6 email, “We are trying very hard to get this resolved for you.”

“I have contacted my provider services manager. She was the first point of contact. Then I went up to her supervisor. He’s the director over provider services. I’ve also emailed the CEO of Anthem. Just everyone’s name that I was given, I’ve contacted via email. That’s primarily how I contact them. I have made some phone calls. I have left some messages. I have contacted the SCC. I have talked with an attorney. So, just everything that I know how to do to try to get their attention and really [have] done pretty much every step.”

The On Your Side Investigators first reached out to Anthem in mid-March. Stoudmire later informed NBC12 that she had re-filed more than 100 claims.

“I’m doing everything that I know how to do to keep my business open and keep my practice alive, because I believe that I provide good services and services that people need. At this point in time, my practice is in jeopardy of closing because of unpaid claims.” she said. “I’ve since made corrections in all of these areas, and the claims are still not being processed. Anthem owes me currently around $26,000 for claims from September 2022 until March of 2023.”

Stoudmire’s story is one shared by other clinicians in the Richmond area. She is no longer taking insurance, which is also becoming more common for some healthcare providers.

In the Richmond area, there are Facebook groups for local clinicians
sharing stories about their insurance struggles.(Anita Stoudmire)

“We have several private Facebook groups here in Richmond for clinicians, and we talk about it within the group all the time. People who are not getting paid, slow to get paid, claw backs, (which is) them paying a claim and then taking the money back. This is a very common practice,” Stoudmire explained. “I’m not the only person that this has happened to. And yes, eventually they let me know that they were starting to get their claims paid again. Eventually, they do get some of their payments. Some people get all of their payments. It just depends. It all ends the same, which is going months and months and months without being paid.”

Stoudmire says she’s following all of the steps the insurance company gave her, but is still waiting for payment.

In a statement, Anthem Insurance explained what providers can do if they are having issues with their claims:

Anthem Blue Cross Blue Shield of Virginia is committed to supporting providers who provide quality care and services to the members in our network. We maintain up-to-date information on our website for providers at Provider Policies, Guidelines and Manuals | Anthem.com for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual, and support for delivering benefits to our members.

Through the secure Availity Essentials system — available 24 hours a day, 7 days a week — participating and non-participating providers can:

  • Submit prior authorization requests.
  • Get current patient insurance coverage information.
  • Submit and monitor the status of claims submissions.
  • View remittance advice.
  • Inquire about previously submitted authorization requests.
  • Dispute a claim payment or denial.
  • Send medical records, invoices, itemized bills, or other requested information.

Providers can always call Provider Services at 800-676-BLUE (2583) to speak to a Provider Service representative.

We encourage providers to submit claims electronically whenever possible. Claims must be submitted within the timely filing timeframe specified in the Provider Agreement and include accurate information for the provider and the member. Claim submission filing tips can be found in the Provider Manual at Provider Manuals | Anthem.com

They also wrote the following about Stoudmire’s situation: “We have worked with Ms. Stoudmire on each of the claims she filed to find resolution for her.”

“A resolution would look like paying all of my claims that are out of date right now. That’s all the way back to September,” said Stoudmire. “We know how important mental health is, especially after going through the pandemic and everything that’s going on in the world. They are keeping their patients from getting the services that they need from the clinician that they have either used for a long period of time or had a connection with.”

Disclaimer: Anthem is the insurance provider for Gray Television, the parent company of NBC12 News.

Source link

Scroll to Top