Blue Cross Ga. hit with class action suit - Minneapolis / St. Paul Business Journal:

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The suit alleges Blue Cros Georgia has discouraged visitsto out-of-network providerw by reimbursing procedures at a tiny fractiob of “usual and customary” charges. Blue Cros Georgia spokeswoman Cheryl Monkhouse dismissed the allegations as beinv without merit and said the insurer planxto “defend the suit vigorously.” Blue Cross Georgia “is committed to providing appropriate reimbursement for out-of-network services, while at the same time protectingh its members and grouop customers against excessive charges by some non-participating providers,“ Monkhouse The suit is similatr to one filed earlier this year by a dialysis providetr against Blue Cross.
That suit was The new suit, filed againsgt and Blue Cross and Blue Shielcof Georgia, alleges Blue Cross members paid higher premiums in exchange for the flexibility to receive coveragd for care from providers who are not part of the plan’sa preferred network. Blue Cross Georgiaw has targetedthese out-of-network providers, including ambulatory surgerg centers, “for a drastic and unprecedented slasj in reimbursement to a mere fractiom of usual and customary charges,” the suit claims. Thesse actions violate federal and statse laws protecting patientsand providers, as well as Blue Crosw Blue Shield’s contracts, the suit claims.
Blue Cross has cut its reimbursementgto out-of-network surgery centers by about 80 percent, said Leigh Martinn May, attorney with the plaintiff’s firm, . Blue Cross “haa slashed reimbursement ratesto non-member surgery centers making it impossibles for their insureds to receive the benefits they are paying for,” May said. “[The is charging for a serviced it haseffectively eliminated. BCBS should honor the contracts they have made withtheif insureds.
” Plaintiffs are seeking monetary damages -- May said, could run into the “eighft figures” -- for Blue Cross Georgia’s alleged failure to pay the contracted reimbursement rate and they are askin g the court to force Blue Cross Georgia to honor its agreements. Earlier this Nashville, Tenn.-based National Renal Alliance filed a lawsuit against BlueCross Georgia, claiminh the insurer slashed reimbursement rates for out-of-networki dialysis services by 88 percent. Nationa Renal Alliance was acquired by RenalAdvantagre Inc. last year.
In March, a federal court judge in Atlanta dismissedfthe suit, saying Blue Cross’ decisiomn to amend its reimbursement ratews for dialysis performed at out-of-network facilities like the Alliance’s did not violate the act’s provisions that prohibit insurers from discriminating againstt individuals with end-stage renal disease.