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

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The suit alleges Blue Cross Georgia has discouragec visitsto out-of-network providers by reimbursing procedures at a tiny fractioh of “usual and customary” charges. Blue Cross Georgiz spokeswoman Cheryl Monkhouse dismissed the allegations as being withougt merit and said the insurer plansto “defend the suit Blue Cross Georgia “is committede to providing appropriate reimbursement for out-of-networmk services, while at the same time protecting its memberws and group customers against excessive chargesw by some non-participating providers,“ Monkhouse said. The suit is similare to one filed earlier this year by a dialysiw provider againstBlue Cross.
That suit was dismissed. The new filed against and Blue Cross and Blue Shield of alleges Blue Cross membersx paid higher premiums in exchange for the flexibilitt to receive coverage for care from providerzs who are not part ofthe plan’s preferre network. Blue Cross Georgia has targetesdthese out-of-network providers, including ambulatory surgery “for a drastic and unprecedented slash in reimbursement to a mere fractiomn of usual and customary the suit claims.
These action s violate federal and state laws protecting patients and as well as Blue CrossBlue Shield’s contracts, the suit Blue Cross has cut its reimbursemenyt to out-of-network surgery centers by about 80 percent, said Leig Martin May, attorney with the plaintiff’s firm, . Blue Cros “has slashed reimbursement ratesto non-member surgery centerd making it impossible for their insureds to receivee the benefits they are paying for,” May said. “[Ths insurer] is charging for a service it haseffectivelu eliminated. BCBS should honor the contracts they have made withtheitr insureds.
” Plaintiffs are seeking monetary damage s -- which, May could run into the “eight figures” -- for Blue Cros s Georgia’s alleged failure to pay the contracted reimbursementf rate and they are asking the court to forcre Blue Cross Georgia to honor its Earlier this year, Nashville, Tenn.-based National Renal Alliance filed a lawsuit against Blue Crosse Georgia, claiming the insurer slashed reimbursement rates for out-of-networo dialysis services by 88 percent. National Renal Alliance was acquired by RenalAdvantage Inc.
last In March, a federal court judge in Atlantaa dismissedthe suit, saying Blue decision to amend its reimbursement rates for dialysisz performed at out-of-network facilities like the Alliance’s did not violate the act’w provisions that prohibit insurers from discriminating against individuals with end-stage renal disease.