Health insurance failures mean trouble for rural hospitals

Ongoing delayed payments from health insurance provider Anthem have left Greene County General Hospital in Linton, Ind., waiting for nearly $1 million in reimbursements.

The hospital served Anthem with a second breach notice May 14.

In the first notice, the hospital said the process by which Anthem processes claims—called adjudication—was handled incorrectly. Anthem acknowledged this, admitting to underpayments as a result, yet the problem remained unresolved.

“In some cases, they’ve paid us a small amount, but it’s still an underpayment, and in other cases, they actually took money back from us,” hospital CEO Brenda Reetz said. “They’ve worked on it, but they just made the error even bigger, so we felt compelled to issue a second breach.”

Reetz said that underpayment affects both patients with private insurance and those with Medicaid.

“Some of the underpayment has actually been passed on to the patients to their deductibles,” Reetz said. “They’re unknowingly being charged more money than what they should be, and not by us, but by their own insurance company that they pay money to be a part of.”

Healthcare providers are already in short supply in Greene County, with just 2.9 medical doctors per 10,000 people. Anthem’s adjudication process further complicates rural healthcare access.

“Just one issue is $1 million. When we add on other issues, it’s much higher than that. And for us a million dollars is a week’s worth of operating money,” Reetz said. “So, this huge for-profit company that has boasted that they’re outperforming their projected revenue for the year, they’re doing that by holding on a rural safety net hospital—they’re actually holding onto their money.”