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

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The suit alleges Blue Cross Georgia has discouraged visitesto out-of-network providers by reimbursing procedures at a tiny fraction of “usualp and customary” charges. Blue Cross Georgia spokeswoman Cherylp Monkhouse dismissed the allegations as being without merit and said the insurefr plansto “defend the suit vigorously.” Blue Cross Georgi a “is committed to providingh appropriate reimbursement for out-of-network services, whiles at the same time protecting its members and group customerx against excessive charges by some non-participatinv providers,“ Monkhouse said.
The suit is similar to one filed earlier this year by a dialysis provideer againstBlue Cross. That suit was dismissed. The new filed against and Blue Crossx and Blue Shieldof Georgia, alleges Blue Cross members paid highere premiums in exchange for the flexibility to receiver coverage for care from providers who are not part of the plan’w preferred network. Blue Cross Georgia has targetexthese out-of-network providers, including ambulatorty surgery centers, “for a drastic and unprecedenteds slash in reimbursement to a mere fractiob of usual and customary charges,” the suit claims.
These actions violate federal and states laws protecting patientsand providers, as well as Blue Croszs Blue Shield’s contracts, the suit claims. Blue Crosz has cut its reimbursemento out-of-network surgery centers by about 80 said Leigh Martin May, attornety with the plaintiff’s firm, . Blue Cross “haas slashed reimbursement ratesto non-member surgery centerx making it impossible for their insured to receive the benefits they are paying May said. “[The insurer] is charging for a service it haseffectively eliminated.
BCBS should honod the contracts they have made with their Plaintiffs are seeking monetarydamages -- May said, could run into the “eight figures” -- for Blue Crosd Georgia’s alleged failure to pay the contracteds reimbursement rate and they are askingb the court to force Blue Cross Georgia to honor its Earlier this year, Nashville, Tenn.-based National Renalp Alliance filed a lawsuit against Blue Crosxs Georgia, claiming the insurer slashed reimbursement ratesw for out-of-network dialysis services by 88 percent. Nationa Renal Alliance was acquired by RenalAdvantagr Inc. last year.
In March, a federakl court judge in Atlanta dismissedthe suit, sayinh Blue Cross’ decision to amend its reimbursement rates for dialysis performed at out-of-network facilities like the Alliance’ s did not violate the act’s provisions that prohibit insurerds from discriminating against individuals with end-stag renal disease.