21/06/2024

Care Health

Prioritize Healthy life

Carbon Health, Anthem Blue Cross of California in public contract dispute

Carbon Health, Anthem Blue Cross of California in public contract dispute

Carbon Health, Anthem Blue Cross of California in public contract dispute

Contract negotiations between virtual primary and urgent care provider Carbon Health and health insurance giant Elevance Health have become public after Carbon published a blog post calling out the insurer for failing to “pay a living wage” for its services provided to members in California. 

The virtual care provider said it has been in talks with Elevance, which operates in the state as Anthem Blue Cross of California, since January 2022 to “negotiate a livable wage and reduce the administrative burden” for the services its care teams provide members in the Golden State.  

Pointing to labor shortages and increasing operating costs, Carbon wrote the rate the insurer had paid since 2013 was no longer feasible.

“Even a meaningful increase to our reimbursement rates would not have brought us anywhere close to what Anthem currently pays other urgent care and primary care providers in California,” the post read. 

As of March 17th, the virtual care provider was no longer considered in-network, according to the post. Yet the company says that many insurers still utilize its service in the state, and as such the company attempted to recoup costs from Elevance as an out-of-network provider.

“We followed our standard practice and submitted Anthem member claims for out-of-network processing, and Anthem has unexpectedly denied every single claim and has so far refused to reimburse us for this care. It now appears that Anthem has stopped processing thousands of claims that we have submitted on behalf of our patients. As a result, some Anthem patients have been charged out of pocket for these unreimbursed bills,” the post read.

Carbon said it would retroactively submit claims in the hope that the insurer would reimburse patients according to their out-of-network benefit, and that it would reduce or refund the difference for patients who have already been charged should Carbon receive reimbursement from Elevance.

The company also said it would only charge patients its standard self-pay cash price should Elevance deny their claim. 

Carbon Health did not immediately respond to a request for comment. 

THE LARGER TREND

Anthem Blue Cross of California was not the only insurer Carbon was covered under. 

In September, the hybrid care provider announced a partnership with Blue Cross Blue Shield of Massachusetts, in which the health insurer would offer its members a virtual primary care option through Carbon Health or Firefly Health. The new primary care model was launched early this year.

Carbon has had an eventful past year, including two rounds of layoffs, letting go of 250 employees or about 8% of its workforce in June 2022, and laying off 200 people earlier this year.

Shortly after the second round of layoffs, Carbon Health announced it received $100 million in Series D investment from CVS Health Ventures. The funding came just two years after the company garnered a massive $350 million investment.