Brentwood, Tenn.-based SpecialtyCare and two affiliated physician groups sued two Anthem health plans, alleging the insurers failed to pay about $2.5 million in No Surprises Act independent dispute resolution awards, according to an Oct. 16 complaint reviewed by Becker’s.
The lawsuit, filed in the U.S. District Court for the Eastern District of Virginia, names Anthem Health Plans of Virginia and HealthKeepers as defendants. SpecialtyCare affiliates Remote Neuromonitoring Physicians and Sentient Physicians joined SpecialtyCare as plaintiffs.
The providers won 1,443 IDR awards totaling roughly $2.75 million, according to the complaint. Anthem had paid about $249,800 as of Oct. 15. The awards span November 2022 to October 2026, and the plaintiffs allege the statutory payment deadlines have passed on every disputed amount.
SpecialtyCare and its affiliates provide intraoperative neuromonitoring, which tracks a patient’s nervous system during surgery. The providers are not challenging the payment determinations. They are asking the court to enforce them, enter judgment for the unpaid balance and award interest.
The complaint seeks enforcement under the No Surprises Act and the Federal Arbitration Act, along with claims under the Employee Retirement Income Security Act tied to certain employer-sponsored plans. For those claims, SpecialtyCare argues it can collect as a beneficiary or through patients’ assigned benefit rights. The suit also alleges Anthem may have breached fiduciary duties on some claims.
Anthem said it will defend against the lawsuit and supports reforms to the federal dispute process in a statement shared by a media representative with Becker’s.
“The federal IDR process has clear eligibility requirements that all parties are expected to follow. We will continue to defend against these actions while supporting reforms that strengthen eligibility standards and ensure IDR remains focused on resolving appropriate out-of-network disputes,” the statement said.
The complaint cites rulings allowing enforcement suits while acknowledging other courts have disagreed, and notes related questions are pending before several federal appeals courts.
Becker’s has reached out to SpecialityCare and will update this article if more information becomes available.
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