Hospitals sue Anthem over patient delays
When a 77-year-old woman was nearly ready to be discharged recently from Henry Mayo Newhall Hospital in Valencia after being treated for a femur fracture following a fall, her doctors recommended that she go to a skilled nursing facility to recover.
They were told by the woman’s health insurer that it could take up to two weeks to authorize the move, said Vicki White, the hospital’s chief nursing officer. Four days later, they tried contacting the insurer again, only to be told to continue waiting. Finally, after multiple attempts, they were able to gain the insurer’s approval. It took 12 days, and the woman remained hospitalized in the meantime despite being medically cleared.
“This is an all too common daily experience,” said White, who shared the example on a call with reporters Tuesday held by the California Hospital Association, which announced a lawsuit against the health insurer Anthem Blue Cross over such alleged delays in care. “This is a growing and troubling trend.”
The hospital association filed the lawsuit in Los Angeles Superior Court, accusing the health insurer of illegally delaying approvals for hospitalized patients to be moved to post-acute care, therefore forcing patients to stay in the hospital for days or weeks longer than they otherwise need to be.
The suit accuses Anthem — one of the state’s largest health insurers with nearly 8 million Californians enrolled in its health plans — of violating a state law, the Knox-Keene Act, by failing to arrange timely access to care for its members as required under the law. It seeks an injunction to stop Anthem from continuing the alleged delays.
The hospital association says such delays are becoming “endemic,” and that Anthem in particular should be held accountable because of its size and reach. It forces patients to remain hospitalized longer than they need to be, despite being medically cleared for discharge, because their insurer has denied or delayed authorization for them to be transferred to post-acute care settings such as facilities that provide skilled nursing, rehabilitation and behavioral health services.
These delays lead to many hours of wasted inpatient care at emergency rooms and result in $3 billion in avoidable hospital costs each year, according to the hospital association, which represents 400 California hospitals. In extreme cases, some patients have languished in hospital beds for up to one year while waiting for their insurer to approve post-discharge services. The delays also prevent emergency departments from being able to care for new patients because beds are still occupied.
Anthem Blue Cross did not immediately respond to the lawsuit.
Each year, about 300,000 Californians — roughly 9% of hospitalized patients statewide — are stuck in hospital beds or emergency rooms waiting at least three days for their insurer to approve and arrange for their discharge, despite being cleared, according to a 2023 survey conducted by the hospital association.
Those who were delayed at least three days ended up spending 14 extra days in the hospital on average, the survey found.
“We are asking the courts to step in where insurance companies are falling short,” said Carmela Coyle, president of the hospital association.