The California Hospital Association is alleging Anthem Blue Cross of California violated the state's patient safety laws by failing to facilitate members' transfer to post-acute care.
In a lawsuit filed in Los Angeles County court April 23, the association alleged Anthem is causing patients to "languish in hospitals when they are ready for post-acute care."
In the complaint, the association alleged around 4,500 patients are waiting in California hospitals and emergency departments for their insurer to approve post-acute care. Anthem is a "key offender," the association alleged.
According to the CHA, in some cases, Anthem has discontinued coverage for ongoing hospital care before the provider and insurer have agreed on a post-discharge treatment plan for the patient. Anthem fails to identify or arrange in-network post-acute care facilities for patients, and "does not timely respond — or respond at all — to requests for authorization for post-acute care for its members," the CHA alleged.
In one example the CHA provided in the lawsuit, an Anthem Blue Cross member was admitted to a hospital, and Anthem authorized four days of inpatient care. The patient was discharged to post-acute care after four days but remained in the hospital for 28 more days after Anthem "failed to arrange" care for the patient, the association alleged.
Anthem denied payment for the 28 days the patient spent in the hospital waiting for a bed in a post-acute care facility, the CHA alleged.
The California Hospital Association represents more than 400 hospitals in the state. Anthem, a subsidiary of Elevance Health, has 7.9 million members in California, according to its website. It is the second-largest insurer in the state, behind Kaiser Permanente, according to CalMatters.
In its complaint, the CHA asked a judge to issue an injunction barring Anthem from denying payment for inpatient care before reaching an agreement with providers on a post-acute care plan for patients.
"Regrettably, far too many insurance companies that put their bottom lines over patient care are violating these essential patient protection laws every day, hurting patients, hospitals and the public good," CHA President and CEO Carmela Coyle said in a news release. "By filing this lawsuit, we are asking the court to put a stop to these illegal practices and force insurers to do what is best for patients."
California law does not specify how quickly insurers must authorize post-acute care, the state's Department of Managed Health Care told CalMatters. Complaints about delayed care are handled on a case-by-case basis.
Becker's has reached out to Anthem Blue Cross of California for comment and will update this article if more information becomes available.