Страховая компания Anthem оштрафована на $520 000 за сотни нарушений в аккредитации врачей и доступе к психиатрической помощи

When a state insurance regulator finds “hundreds of violations” against a major health insurer, that is not a technical compliance story. It is a patient story. The New Hampshire Insurance Department issued a Final Order on November 24, 2025 fining Anthem Health Plans of New Hampshire Inc. and its subsidiary Matthew Thornton Health Plan $520,000 for violations identified during a targeted market conduct examination covering January 1, 2022 through November 30, 2023. The examination identified hundreds of violations of state and federal requirements in three specific areas: provider credentialing, provider directory accuracy, and mental health parity compliance. Each of those three categories represents a specific way that New Hampshire residents with Anthem coverage may have been harmed during that two-year period. The Provider Directory Problem — When the List Is Wrong When you look up a doctor in your insurer’s online directory and see them listed as in-network, you make an appointment. You see the doctor. You pay the in-network copay. Then the bill arrives showing the visit was processed as out-of-network — because the doctor in the directory had not been properly credentialed within the required timeframe, or because the directory information was simply wrong. The New Hampshire Insurance Department found that Anthem failed to maintain required documentation for its provider directories and identified instances where a provider had not been credentialed within the statutory timeframe. A provider who has not been credentialed within the required window is technically not in-network regardless of what the directory says. Patients who relied on the directory and received care from those providers during the 2022-2023 period may have faced out-of-network cost-sharing they did not expect and may not have legally owed. The Credentialing Failure — When Anthem Did Not Know Who Was in Its Network Commissioner D.J. Bettencourt said Anthem did not sufficiently monitor the performance of third-party entities that credentialed providers for the insurance firm. Insurance companies do not always credential their own doctors. They outsource that function to third-party organizations. When the third-party fails to credential providers properly — and the insurer does not monitor that process adequately — the breakdown shows up in the form of incorrect provider directories, improper claim denials, and confused billing. New Hampshire Anthem members who had claims denied between 2022 and 2023 involving a provider who turned out to be incorrectly credentialed have grounds to request a review of those claims. The NHID finding that the credentialing process was inadequate creates a documented basis for challenging denials from that period. The Mental Health Parity Violation — the Quiet Harm Mental health parity is a federal and state legal requirement. Insurers cannot impose more restrictive limits on mental health or substance use disorder benefits than they impose on comparable medical or surgical benefits. When an insurer violates mental health parity, the harm shows up quietly — a therapy visit limit that is lower than the comparable medical limit, a prior authorization requirement for mental health treatment that does not apply to comparable physical health treatment, a higher cost-sharing requirement for psychiatric care than for equivalent medical care. The NHID found mental health parity violations as part of the same examination that produced the credentialing findings — covering the same January 2022 to November 2023 period. New Hampshire Anthem members who sought mental health or substance use disorder treatment during that period and encountered coverage limitations or denials have a specific regulatory finding supporting a closer look at whether those limits were legally applied. What the Fine Structure Tells You About Future Compliance Anthem must pay $300,000 of the $520,000 fine within 30 days of the order — which was due in late December 2025. The remaining $220,000 is suspended for two years and will be waived if Anthem complies with the corrective plan and maintains ongoing compliance with all applicable laws and regulations. That suspended portion is a compliance incentive. If Anthem fixes the problems and demonstrates ongoing compliance through late 2027, $220,000 of the fine disappears. Deputy Commissioner Keith Nyhan framed the outcome constructively: “The department appreciates Anthem’s constructive engagement and its collaboration in developing a corrective plan.” Anthem’s statement acknowledged the findings and committed to compliance. The corrective plan means New Hampshire Anthem members in 2026 should theoretically have a more accurate provider directory, a better-monitored credentialing process, and mental health parity compliance that meets legal standards. Whether that is happening is something the NHID can — and presumably will — verify before the $220,000 suspension period ends. The Broader Anthem Pattern Worth Knowing New Hampshire’s action is not happening in isolation. Indiana passed a law banning Anthem’s hospital penalty policy — making it the only state in the country to do so. Georgia, Kentucky, and nine other states still have the active Anthem hospital penalty affecting how hospitals are paid when out-of-network physicians are involved. California is in federal court over Anthem’s lawsuit against 11 Prime Healthcare hospitals for allegedly gaming the No Surprises Act arbitration process. Virginia is watching a December 31 deadline with Sentara. New Hampshire’s fine is a state-level accountability action against a national insurer with simultaneous disputes and regulatory actions in multiple states. The $520,000 fine is not large relative to Elevance Health’s reported $5.7 billion in quarterly profit. But it is specific. It is documented. And it is public. New Hampshire Anthem members with questions about claims from 2022-2023 can contact the New Hampshire Insurance Department at 1-800-852-3416 or at insurance.nh.gov. Sources - ✅ New Hampshire Insurance Department official — Final Order November 24, hundreds of violations, three categories, $300K pay/$220K suspended, Commissioner Bettencourt, Deputy Nyhan quote, January 2022-November 2023 period, corrective plan required - ✅ Yahoo Finance / Union Leader — $520,000 total fine, Matthew Thornton subsidiary, Anthem statement, third-party credentialing monitoring failure, provider directory, mental health parity, November 24, 2025 - ✅ Davis Wright Tremaine — Anthem 10% hospital penalty active in New Hampshire, 11-state list confirmed, effective January 1 2026, Indiana only state to ban, December 3, 2025