Anthem Blue Cross under fire for ‘refusing to' help NYC crack down on soaring health care costs, new report shows

Yahoo

23-03-2025

An inaugural report by the New York City Health Department aimed at cracking down on sky-high prices hospitals charge patients has gaping holes in it because the Big Apple's largest public-employee insurer refuses to turn over records, officials said.
The 263-page report quietly released Friday through the agency's new Office of Healthcare Accountability says hospital prices are wildly inconsistent. The study focused on payments made through the city's health care provider, Anthem Blue Cross, and not private-sector insurance plans.
The city's GHI-Comprehensive Benefits Plan through Anthem paid on average $45,150 for inpatient services last fiscal year at New York's top 10 hospital systems, the report said.
The highest prices for full in-patient treatment were at New York-Presbyterian ($92,727) and Montefiore Medical Center ($83,573), while Stony Brook University Hospital was the lowest ($36,876).
The report noted the city spent $3.3 billion paying for employee hospital care during the fiscal year ending June 30, and half went to three hospital systems: Northwell Health ($759 million), New York-Presbyterian ($485 million) and NYU Langone Health ($443 million).
New York-Presbyterian had the highest prices for 11 of 12 inpatient procedures analyzed and 14 of 27 outpatient procedures, the report said.
Prices at hospital systems ranged widely, from $940 to $12,000 for a colonoscopy, and $7,000 to $58,000 for a cesarean-section delivery.
And the city is now spending more on hospital outpatient care than inpatient.
The report cited Anthem — which the city pays a whopping $3 billion yearly to provide insurance to roughly 900,000 employees — for refusing to provide the OFA the full costs of health care at hospitals and other data it needs to determine whether these prices are warranted.
Anthem claimed releasing some of the pricing data would violate confidentiality agreements it has with hospitals that predate a 2021 federal rule requiring hospitals to disclose their prices to the public.
However, Councilwoman Julie Menin (D-Manhattan), who sponsored legislation creating the first-of-its-kind health care watchdog office in 2023, isn't buying it.
'It's a slap in the face to the City of New York when federal rules require hospital pricing be made public, but Anthem won't comply with city law due to so-called 'preexisting agreements,'' she said. 'This health care industry cat-and-mouse game is costing the city billions, and we need full transparency now.'
'It's so distressing to see these prices,' added Menin. 'It's extremely high and is why we need price transparency. Why should New York City be paying so much for health care? It's sickening and unsustainable.'
The city's health care insurance contract is up later this year, and the city 'must require full disclosure of pricing' to whoever gets it,' said Menin. Anthem is among the bidders for the new deal.
The Post two years ago reported on analyses by 32BJ SEIU, the city's building-services employee union, showing the Big Apple could save taxpayers as much as $2 billion annually by auditing exactly how much municipal workers pay for care at various hospitals and making recommendations on ways to lower the prices.
Manny Pastreich, president of 32BJ, said his union pushed hard to create the OFA but added it's unfortunate the 'inaugural report is more noteworthy for what is missing.'
'It's clear that hospitals and insurers are still exerting their influence to block sharing certain data the city needs to reverse the trend of exorbitant health care costs,' he said.
The OFA was created in large part to offer greater transparency to patients on costs of medical procedures at a private hospital vs. city-run medical facilities as it has the authority to publicly release hospital pricing citywide. It operates with a $2 million budget and 15 staffers.
'Health insurance companies and New York City hospitals must remove arbitrary barriers to data access that would otherwise support transparent and equitable pricing of medical services,' said Henry Garrido, executive director of District Council 37, the city's largest municipal employee union.
'We must utilize every tool at our disposal to fight these unfair practices, including ensuring the Office of Healthcare Accountability is adequately staffed to fulfill its primary purpose of tackling disparity pricing that exploits the vulnerabilities of New Yorkers in need of care.'
Anthem reps did not immediately return messages.