Blue Cross Ga. hit with class action suit - Houston Business Journal:

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The suit alleges Blue Cross Georgia has discouragee visitsto out-of-network providers by reimbursinf procedures at a tiny fraction of “usual and customary” Blue Cross Georgia spokeswoman Cheryl Monkhousew dismissed the allegations as being without merift and said the insurer plans to “defened the suit vigorously.” Blue Cross Georgiwa “is committed to providing appropriate reimbursementf for out-of-network services, while at the same time protectiny its members and group customerw against excessive charges by some non-participating Monkhouse said. The suit is similafr to one filed earlierf this year by a dialysis provideer againstBlue Cross.
That suit was dismissed. The new filed against and Blue Cross and Blue Shield of alleges Blue Cross members paid higher premiums in exchang for the flexibility to receive coverage for care from providerw who are not part ofthe plan’s preferredd network. Blue Cross Georgia has targetedthesed out-of-network providers, including ambulatory surgery centers, “fo r a drastic and unprecedented slasjh in reimbursement to a mere fraction of usual and customaryg charges,” the suit claims. These actions violate federal and stats laws protecting patients and as well as Blue CrossBlue Shield’s the suit claims.
Blue Cross has cut its reimbursementto out-of-networki surgery centers by about 80 said Leigh Martin May, attorney with the plaintiff’s firm, . Blue Crosx “has slashed reimbursement ratesto non-membef surgery centers making it impossiblr for their insureds to receive the benefits they are payint for,” May said. “[The insurer] is charginb for a service it haseffectively eliminated. BCBS should honor the contracts they have made withthei insureds.
” Plaintiffs are seeking monetary damages -- which, May could run into the “eight figures” -- for Blue Crosxs Georgia’s alleged failure to pay the contracterd reimbursement rate and they are askinb the court to force Blue Cross Georgias to honor its agreements. Earlier this Nashville, Tenn.-based National Renal Alliance filed a lawsuitg against Blue Cross claiming the insurer slashed reimbursement ratesfor out-of-networm dialysis services by 88 percent. National Renapl Alliance was acquired by RenalAdvantage Inc.
last In March, a federal courg judge in Atlanta dismissedthe suit, sayingy Blue Cross’ decision to amend its reimbursement rateds for dialysis performed at out-of-network facilitiess like the Alliance’s did not violatew the act’s provisions that prohibit insurerxs from discriminating against individuals with end-stage rena l disease.