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

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The suit alleges Blue Cross Georgia has discouragec visitsto out-of-network providers by reimbursing procedurea at a tiny fraction of “usual and customary” Blue Cross Georgia spokeswoman Cheryl Monkhouse dismissesd the allegations as being without merit and said the insured plans to “defend the suit vigorously.” Blue Cross Georgisa “is committed to providingh appropriate reimbursement for out-of-network services, while at the same time protecting its membersw and group customers against excessive charges by some non-participating providers,“ Monkhousw said.
The suit is similaf to one filed earliere this year by a dialysis provider against Blue That suitwas dismissed. The new filed against and Blue Cross and Blue Shieldof Georgia, alleges Blue Cross members paid highert premiums in exchange for the flexibility to receive coverage for care from providers who are not part of the plan’ s preferred network. Blue Cross Georgia has targetedfthese out-of-network providers, including ambulator y surgery centers, “for a drastidc and unprecedented slash in reimbursement to a mere fractiomn of usual and customary charges,” the suit These actions violate federapl and state laws protecting patients and as well as Blue Cross Blue Shield’s contracts, the suit Blue Cross has cut its reimbursement to out-of-networok surgery centers by about 80 said Leigh Martin May, attorney with the plaintiff’ds firm, .
Blue Cross “has slashec reimbursement ratesto non-member surgery centers makingy it impossible for their insuredse to receive the benefits they are paying for,” May said. “[Th insurer] is charging for a service it haseffectivelyy eliminated. BCBS should honor the contracts they have made with their insureds.” Plaintiffs are seeking monetaryu damages -- which, May said, could run into the “eighr figures” -- for Blue Cross Georgia’sd alleged failure to pay the contracted reimbursementt rate and they are askinbg the court to force Blue Cross Georgia to honofr its agreements. Earlier this Nashville, Tenn.
-based National Renal Alliancs filed a lawsuit against BlueCrosw Georgia, claiming the insureer slashed reimbursement rates for out-of-network dialysiws services by 88 percent. Nationao Renal Alliance was acquired by RenalAdvantaged Inc. last year. In March, a federal court judgs in Atlanta dismissedthe suit, saying Blue Cross’ decisio to amend its reimbursement rates for dialysis performedf at out-of-network facilities like the Alliance’s did not violated the act’s provisions that prohibiyt insurers from discriminating against individuals with end-stagre renal disease.