Blue Cross Blue Shield of Maine responds to Congresswoman Chellie Pingree's letter to pay about a half-million dollars in denied claims
Congresswoman Chellie Pingree welcomed a decision by Anthem Blue Cross and Blue Shield of Maine to reconsider hundreds of thousands of dollars in claims made by VA Togus that had been previously denied.
 
“I think Anthem was being unreasonable in the first place and it was unfair to deny those claims,” Pingree said.  “So I’m glad to see they’ve had a change of heart.”
 
Anthem began paying the previously denied claims last week.
 
Last month, Pingree wrote to Daniel Corcoran, President of Anthem Blue Cross and Blue Shield of Maine, asking that the company pay nearly $500,000 in claims owed to VA Togus.  Anthem had changed reporting requirements and only informed VA Togus through a small item in a newsletter.  The claims involved veterans who are covered by Anthem’s Federal Employee Program who had received services at Togus.  For years Anthem had allowed VA Togus until December 31st of the year following the date of service for a procedure to file a claim.  Last year Anthem changed that “timely filing deadline” to 120 days.
 
In her letter to Corcoran, Pingree wrote:
 
“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.
 
“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.”
 
According to officials at VA Togus, Anthem Blue Cross Blue Shield of Maine 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.