RICHMOND — The State Corporation Commission (SCC) has granted in part and denied in part the request by Anthem Health Plans of Virginia to relax restrictions on its ability to perform certain services and operations outside of Virginia. The restrictions were conditions the SCC required when approving the 2002 merger of Trigon Healthcare and Anthem. Subsequently, Anthem and Wellpoint Health Networks merged.
In its final order, the Commission concluded that Anthem should be required to continue to provide the following services from offices located in Virginia –
- claims processing and case management
- quality management
- medical management
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- customer service
- provider services
- network development
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The SCC said these services “are those that involve daily and direct communication between Anthem and its enrolled customers or health-care providers in Virginia.” As such, maintaining offices in Virginia to provide these services “is necessary to protect the interests of the policyholders of the insurer and the public” as directed by Virginia insurance law.
Although the Commission is not precluding Anthem from future requests to locate such services out of Virginia, it found that “Anthem has not met its burden of proof of persuading us that its plans – whatever they may be – for providing such critically important services from outside the Commonwealth will not degrade the quality of communications and service to Virginians.”
Anthem may provide the following services from offices outside of Virginia –
- actuarial
- marketing
- distribution management
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- underwriting
- community relations
- sales
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The Commission said it recognizes that consolidation of services in the health care industry can make health care delivery more efficient and cost effective. As such, Anthem is free in the future to file another petition to remove any of the remaining conditions.
When filing such petition, the Commission expects a specific proposal for providing such services out of state, including detailed information on how and where Anthem will provide such services, as well as credible safeguards to ensure that the quality of communications and service to Virginians is not degraded.
The SCC said, “We cannot evaluate such safeguards without knowing exactly what Anthem’s specific plans are to move such important services outside of the Commonwealth.”
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Case Number INS-2007-00141