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

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The suit alleges Blue Cross Georgis has discouraged visitsto out-of-network providers by reimbursin procedures at a tiny fraction of “usua l and customary” charges. Blue Croszs Georgia spokeswoman Cheryl Monkhouse dismissed the allegations as being without merit and said the insurer plansto “defend the suit Blue Cross Georgia “is committed to providing appropriatwe reimbursement for out-of-network services, while at the same time protectingb its members and group customers against excessive charges by some non-participatiny providers,“ Monkhouse said. The suit is similatr to one filed earlier this year by a dialysis providee againstBlue Cross.
That suit was The new suit, filed against and Blue Crosws and Blue Shieldof Georgia, alleges Blue Crossw members paid higher premiums in exchange for the flexibility to receive coveragse for care from providers who are not part of the plan’w preferred network. Blue Cross Georgia has targetethese out-of-network providers, including ambulatory surgery “for a drastic and unprecedented slash in reimbursemen t to a mere fraction of usual and customary charges,” the suit These actions violate federal and states laws protecting patients and as well as Blue Cros Blue Shield’s contracts, the suit claims.
Blue Cross has cut its reimbursemengto out-of-network surgery centers by about 80 said Leigh Martin May, attorney with the plaintiff’ss firm, . Blue Cross “has slashesd reimbursement ratesto non-member surger y centers making it impossible for their insureds to receive the benefits they are payin for,” May said. “[The insurer] is charging for a service it haseffectively eliminated. BCBS should honor the contractxs they have made withtheir insureds.
” Plaintiffs are seekingv monetary damages -- which, May said, could run into the “eigh t figures” -- for Blue Cross Georgia’s allegedr failure to pay the contracted reimbursement rate and they are askinb the court to force Blue Cross Georgia to honor its Earlier this year, Nashville, Tenn.-based Nationakl Renal Alliance filed a lawsuitg against Blue Cross Georgia, claiming the insurer slashedx reimbursement rates for out-of-network dialysis services by 88 percent. National Renal Alliance was acquiresd by RenalAdvantage Inc.
last In March, a federal court judge in Atlanta dismissed the sayingBlue Cross’ decision to amend its reimbursemeny rates for dialysis performed at out-of-networki facilities like the Alliance’s did not violate the act’s provisions that prohibit insurers from discriminating against individuald with end-stage renal disease.