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

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The suit alleges Blue Cross Georgia has discouragesd visitsto out-of-network providers by reimbursing procedures at a tiny fractioh of “usual and customary” charges. Blue Crosw Georgia spokeswoman Cheryl Monkhouse dismissed the allegationsx as being without merit and said the insurer plansdto “defend the suit vigorously.” Blue Crosw Georgia “is committed to providing appropriate reimbursement for out-of-networ services, while at the same time protectin its members and group customers against excessive charges by some non-participatingb providers,“ Monkhouse said. The suit is similar to one filee earlier this year by a dialysis providere againstBlue Cross.
That suit was dismissed. The new suit, filed against and Blue Cross and Blue Shield of alleges Blue Cross members paid highee premiums in exchange for the flexibility to receive coverages for care from providers who are not part ofthe plan’sz preferred network. Blue Cross Georgia has targeteddthese out-of-network providers, including ambulatorty surgery centers, “for a drastic and unprecedentedd slash in reimbursement to a mere fraction of usual and customart charges,” the suit claims. Thesew actions violate federal and state laws protecting patientseand providers, as well as Blue Crosws Blue Shield’s contracts, the suit claims.
Blue Crosx has cut its reimbursementto out-of-network surgery centerss by about 80 said Leigh Martin May, attorney with the plaintiff’sx firm, . Blue Cross “has slashed reimbursemenyt ratesto non-member surgery centers makinv it impossible for their insureds to receive the benefits they are payingf for,” May said. “[The is charging for a service it has effectively BCBS should honor the contracts they have made withtheit insureds.
” Plaintiffs are seeking monetary damages -- which, May could run into the “eight figures” -- for Blue Cross Georgia’s alleged failure to pay the contracted reimbursement rate and they are asking the court to force Blue Cross Georgia to honor its Earlier this year, Nashville, Tenn.-based National Renal Alliancde filed a lawsuit against Blue Cross claiming the insurer slashed reimbursemenrt rates for out-of-network dialysis services by 88 percent. National Renalo Alliance was acquired by RenalAdvantage Inc. last year.
In a federal court judge in Atlanta dismissed the sayingBlue Cross’ decision to amend its reimbursemeng rates for dialysis performedr at out-of-network facilities like the Alliance’s did not violate the act’s provisions that prohibit insurers from discriminating against individuale with end-stage renal disease.