Brentwood, Tenn.-based SpecialtyCare and two affiliated physician groups sued Anthem Blue Cross and Blue Shield’s Colorado entity. The lawsuit alleges the insurer failed to pay about $501,430 in No Surprises Act independent dispute resolution awards, according to an Oct. 13 complaint reviewed by Becker’s.
The lawsuit, filed in the U.S. District Court for the District of Colorado, names Rocky Mountain Hospital and Medical Service, which does business as Anthem Blue Cross and Blue Shield, as the defendant. SpecialtyCare affiliates Remote Neuromonitoring Physicians and Sentient Physicians joined SpecialtyCare as plaintiffs.
The providers won 287 IDR award line items totaling $608,652, according to the complaint. Anthem had paid about $107,218 as of Sept. 24. The awards span November 2022 to June 2026, and the plaintiffs allege the 30-day federal payment deadline has passed on every unpaid amount.
SpecialtyCare and its affiliates provide intraoperative neuromonitoring, which tracks a patient’s nervous system in real time during surgery. The providers are not asking the court to revisit the awards. They want the court to confirm them, enter judgment for the unpaid balance and award interest.
The complaint seeks enforcement under the No Surprises Act and the Federal Arbitration Act. It also brings claims under the Employee Retirement Income Security Act tied to self-funded employer plans Anthem administers. For those claims, SpecialtyCare argues it can collect as a beneficiary in its own right or through patients’ assigned benefit rights. The lawsuit also alleges Anthem may have breached fiduciary duties on some claims.
The complaint cites district court rulings in Connecticut and Maryland that allowed enforcement lawsuits. It acknowledges that the 5th Circuit and 2nd Circuit ruled the other way, and it notes that SpecialtyCare has related appeals pending in the 3rd, 7th and 9th circuits.
The lawsuit comes amid ongoing No Surprises Act legal disputes with SpecialtyCare. The group has a separate complaint, filed Oct. 16 in the U.S. District Court for the Eastern District of Virginia, that targets Anthem Health Plans of Virginia and HealthKeepers over an alleged $2.5 million in unpaid awards.
Becker’s has reached out to Anthem for comment and will update this article if more information becomes available.
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