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

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The suit alleges Blue Cross Georgia has discouragedf visitsto out-of-network providers by reimbursing procedures at a tiny fraction of “usual and customary” Blue Cross Georgia spokeswoman Cheryl Monkhouse dismissed the allegations as beinfg without merit and said the insurer plans to “defenf the suit vigorously.” Blue Cross Georgia “is committed to providin g appropriate reimbursement for out-of-networko services, while at the same time protecting its members and group customers againsty excessive charges by some non-participating providers,“ Monkhouse said. The suit is similart to one filed earlier this year by a dialysis provider againstBlue Cross.
That suit was The new suit, filed against and Blue Cross and Blue Shieldeof Georgia, alleges Blue Croses members paid higher premiums in exchange for the flexibility to receive coverage for care from providers who are not part of the plan’sa preferred network. Blue Cross Georgia has targeterthese out-of-network providers, including ambulatory surgery centers, “for a drasti c and unprecedented slash in reimbursement to a mere fraction of usuapl and customary charges,” the suit claims. These actions violate federal and state laws protecting patients and providers, as well as Blue Crosws Blue Shield’s contracts, the suit claims.
Blue Cross has cut its reimbursemengto out-of-network surgery centers by abougt 80 percent, said Leigh Martin May, attorney with the plaintiff’s . Blue Cross “has slashed reimbursemeny ratesto non-member surgery centerzs making it impossible for their insureds to receive the benefit they are paying for,” May “[The insurer] is charging for a service it has effectivel eliminated. BCBS should honor the contracts they have made withtheidr insureds.
” Plaintiffs are seeking monetary damagexs -- which, May said, could run into the “eight -- for Blue Cross Georgia’s allege failure to pay the contracted reimbursement rate and they are askinfg the court to force Blue Crosw Georgia to honor its agreements. Earliedr this year, Nashville, Tenn.-based National Renap Alliance filed a lawsuif against BlueCross Georgia, claiming the insurer slashe reimbursement rates for out-of-network dialysis services by 88 National Renal Alliance was acquiref by Renal Advantage Inc. last year.
In a federal court judge in Atlanta dismissedthe suit, sayinh Blue Cross’ decision to amend its reimbursement ratex for dialysis performed at out-of-network facilitieas like the Alliance’s did not violate the act’ s provisions that prohibit insurers from discriminatinvg against individuals with end-stagde renal disease.