In January 2010, I wrote to Daniel Corcoran, President of Anthem Blue Cross and Blue Shield of Maine, demanding that the company pay nearly $500,000 in claims owed to the VA Togus Medical Center in Augusta. The claims involved veterans who receive care at VA Togus and are covered by Anthem’s Federal Employee Program. For years, VA Togus officials had one year to bill Anthem for the services provided to our veterans. Anthem had recently reduced the “timely filing deadline,” or the amount of time Togus officials could submit claims, from one year to 120 days. How did Anthem notify the VA Hospital regarding this important change? A quick statement on the second page of a newsletter- a newsletter that VA Togus officials have no record of receiving.

Not only did this sudden and unexpected change in policy result in a substantial loss of money for VA Togus, it presents an unreasonable burden on the Medical Center going forward. Numerous claims would have been denied and there would be a further negative impact on Togus’ operating budget.

Following my letter, Anthem reversed the decision and has agreed to allow VA Togus to resubmit the previously denied claims. Togus officials also expect the timely filing window to be extended to 12 months. 

Read the Bangor Daily News editorial about this issue »

My letter to Anthem:

Mr. Daniel P. Corcoran, President
Anthem Blue Cross and Blue Shield of Maine
2 Gannett Drive
South Portland, Me 04106

Dear Mr. Corcoran,

I am writing today to express my concern about a recent decision by Anthem Blue Cross Blue Shield to dramatically reduce the time that providers have to file claims for individuals covered by the Federal Employees Program.  Because of this change, nearly $500,000 in claims filed by the VA Togus Medical Center in my home state of Maine were denied before Togus officials were made aware of the change.  The loss of these payments will ultimately harm the veterans who use services provided at Togus.

At issue are claims for services provided to veterans covered by the Anthem Blue Cross Blue Shield Federal Employees Program.  For years, Anthem gave VA Togus and other health care providers a reasonable period of time to submit claims—until December 31st of the year following the date of service.   Last year, Anthem unilaterally changed the timely claim filing period to just 120 days.  The only notification of this change in policy was a small item on the second page of an Anthem newsletter—a newsletter that Togus officials have no record of receiving.

Not only did this sudden and unexpected change in policy result in a substantial loss of money for VA Togus, it presents an unreasonable burden on the Medical Center going forward.  If Togus employees are only allowed 120 days to process all claims under the Federal Employees Program, I expect numerous claims will be denied and there will be a further negative impact on Togus’ operating budget.

I ask that Anthem Blue Cross Blue Shield process the claims submitted by the VA Togus Medical Center between May 1, 2009 and September 30, 2009 that you have previously denied.  I also ask that you reconsider your decision to reduce the timely filing deadline to just 120 days.

The men and women at VA Togus work tirelessly to provide the care that our veterans deserve.  Your denial of nearly half a million dollars in claims places a significant burden on a hospital that is already struggling with budget shortfalls.  And failing to adequately notify officials of this significant change in policy seems like an arbitrary decision intended to give an insurance company an excuse to deny legitimate claims for service.   

I look forward to a timely response.

Sincerely,

Chellie Pingree
Member of Congress