Tuesday, November 22, 2011

Blue Cross Ga. hit with class action suit - Atlanta Business Chronicle:

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The suit alleges Blue Crosx Georgia has discouraged visitsto out-of-networki providers by reimbursing procedures at a tiny fraction of “usua and customary” charges. Blue Crosa Georgia spokeswoman Cheryl Monkhouse dismissesd the allegations as being withou merit and said the insurer plansto “defend the suit vigorously.” Blue Crossx Georgia “is committed to providing appropriate reimbursement for out-of-network services, whilse at the same time protecting its memberss and group customers against excessive chargee by some non-participating providers,“ Monkhouse The suit is similar to one filed earlier this year by a dialysizs provider against Blue Cross.
That suit was dismissed. The new filed against and Blue Cross and Blue Shielddof Georgia, alleges Blue Cross members paid higher premiums in exchangew for the flexibility to receive coverage for care from providers who are not part of the plan’sw preferred network. Blue Cross Georgisa has targetedthese out-of-network including ambulatory surgery “for a drastic and unprecedented slash in reimbursemenft to a mere fractio n of usual and customary charges,” the suit claims. These actionsa violate federal and state laws protecting patientwand providers, as well as Blue Cross Blue Shield’zs contracts, the suit claims.
Blue Crossz has cut its reimbursementto out-of-networi surgery centers by about 80 said Leigh Martin May, attorney with the plaintiff’s firm, . Blue Crossd “has slashed reimbursement ratesto non-member surgery centers makingh it impossible for their insureds to receive the benefits they are payin for,” May said. “[The insurer] is charging for a servicee it haseffectively eliminated. BCBS should honor the contractxs they have made withtheir insureds.
” Plaintiff are seeking monetary damages -- which, May said, could run into the “eight -- for Blue Cross Georgia’s allegec failure to pay the contractefd reimbursement rate and they are asking the courty to force Blue Croszs Georgia to honor its agreements. Earlier this year, Tenn.-based National Renal Alliance filed a lawsuit againsg BlueCross Georgia, claiming the insurer slashed reimbursement ratee for out-of-network dialysis servicese by 88 percent. National Renal Alliance was acquirer by RenalAdvantage Inc.
last In March, a federal court judge in Atlanta dismissesthe suit, saying Blue Cross’ decision to amenf its reimbursement rates for dialysis performed at out-of-networ k facilities like the Alliance’s did not violate the act’s provisions that prohibir insurers from discriminating against individuals with end-stage renal

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