“We operate under the belief that vendors don’t want us to know their business because it won’t be good for them, so we remove that barrier as best we can.”
By Julie Selesnick• Counsel at Berger Montague on Linkedin
Several months ago we learned that Justin Leader of BenefitsDNA, Stephen Carrabba of ClaimInformatics and Josh Spivak of Highlight Health were being stonewalled by Anthem in their attempts to access and review claims data for various #healthplans that they contracted with to provide services as #businessassociates. Anthem’s refusal to allow the health plans access to their own #claimsdata violates the #CAA of 2021 and #ERISA and makes it impossible for plan #fiduciaries to effectively monitor its performance under the #administrativeservices agreements.
IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF CONNETICUT
Trustees of International Union of Bricklayers & Allied Craftworker vs Anthem Health Plans
PLEADING: “Anthem failed to apply the discounts as promised in the Plaintiffs’ ASOs and failed to pass on the entire discount to which each plan was entitled based on the rates negotiated between Anthem and the providers in the Anthem network.” – Trustees of the International Union of Bricklayers and Allied Craftworkers Local 1 Connecticut Health Fund et al v. Elevance, Inc. et al 3:2022cv01541 | US District Court for the District of Connecticut | Justia
ANTHEM WEBSITE: “Union boards have access to plenty of information on member activities and preferences. Building better union member health plans starts with turning that data into actionable insights” – Union Member Health Plans: What Do They Really Want? | Anthem Labor and Trust
