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According to the California Hospital association Anthem Blue Cross, one of California’s largest health insurance companies, consistently leaves thousands of its patients stranded in hospital beds long after they have been medically cleared for discharge, a violation of California law. These victims of discharge delays are forced to stay in hospitals longer, are deprived of timely post-hospital health care services, and cause backlogs for other patients who have to wait longer for hospital beds.

These failures, along with Anthem’s disregard of state requirements to maintain an adequate network of care providers and not paying for the additional hospital care it forces to be provided to patients, are the basis of a new lawsuit filed in Los Angeles County Superior Court against the insurance giant by the California Hospital Association (CHA) on behalf of the state’s more than 400 hospitals and health systems and the patients they serve.

“California has some of the strongest laws in the nation governing insurance company practices,” said CHA President & CEO Carmela Coyle. “Regrettably, far too many insurance companies that put their bottom lines over patient care are violating these essential patient protection laws every day, hurting patients, hospitals, and the public good. By filing this lawsuit, we are asking the court to put a stop to these illegal practices and force insurers to do what is best for patients.”

According to a statewide survey of hospitals conducted last year by CHA, an estimated 4,500 Californians are stuck every day in hospital beds and emergency departments waiting for their insurers to approve and arrange for their discharge to care settings such as skilled-nursing facilities, home health services, rehabilitation facilities, or behavioral health services. According to the survey, patients whose discharge is delayed by at least three days (~300,000 patients annually) spend, on average, an additional 14 days in the hospital after being medically cleared for post-acute care.

Other findings from the survey include:

– – California hospitals provide an estimated 1 million days of unnecessary inpatient care and 7.5 million hours of wasted emergency department care annually due to discharge delays.
– – In some extreme cases, patients – especially those experiencing behavioral health issues – have languished in hospital beds for as long as a year.
– – These delays result in at least $3.25 billion in avoidable hospital costs every year.
– – Patients enrolled in managed care plans – especially those covered by Medi-Cal – are more likely to experience delays than those who have fee-for-service coverage.

The lawsuit alleges that Anthem fails to meet its legal obligations to arrange for timely access to care for its members as required under California law. Anthem is also accused of not responding in a timely manner – or at all – “to requests for authorization” for post-acute care for its members.

Additionally, the complaint charges Anthem with “unilaterally discontinuing authorization” for hospitals to continue caring for patients while they need to remain in hospital beds longer as a result of the insurance company’s failure to arrange for timely post-acute discharge.

In the lawsuit, CHA is seeking an injunction against Anthem that would bar the insurer from engaging in these illegal and harmful business practices.

“It is time for the courts to hold insurers accountable by enforcing the law. Care that is delayed is care that is denied,” Coyle said.  Coyle also said the association has raised the issue with the Department of Managed Health Care, which oversees most health insurers.

In a statement, department spokesperson Kevin Durwara said the agency has been meeting with the hospital association to address hospitals’ “concerns and challenges” with insurance delays since 2021. The meetings resulted in a letter issued to insurers in Fresno County, where hospital capacity was particularly limited, instructing them to make it easier for hospitals to discharge patients.

According to CalMatters a spokesperson for Anthem said the company did not have an immediate response and would be investigating the allegations.