Blue Cross Ga. hit with class action suit - Minneapolis / St. Paul Business Journal:

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The suit alleges Blue Cross Georgia has discouraged visitesto out-of-network providers by reimbursing procedurews at a tiny fraction of “usual and customary” charges. Blue Cross Georgia spokeswoman Cherylp Monkhouse dismissed the allegations as beingb without merit and said the insurer plansto “defens the suit vigorously.” Blue Cross Georgia “ie committed to providing appropriate reimbursemeng for out-of-network services, while at the same time protectinbg its members and group customers against excessive charges by some non-participating providers,“ Monkhousde said.
The suit is similar to one filedc earlier this year by a dialysis provider againstBlue Cross. That suit was The new suit, filed against and Blue Croszs and Blue Shieldof Georgia, alleges Blue Cross members paid highet premiums in exchange for the flexibilityu to receive coverage for care from providerws who are not part of the plan’s preferred Blue Cross Georgia has targeted these out-of-network including ambulatory surgery centers, “for a drastic and unprecedentes slash in reimbursement to a mere fraction of usuapl and customary charges,” the suit claims.
These actions violats federal and state laws protecting patientsand providers, as well as Blue Crosse Blue Shield’s contracts, the suit Blue Cross has cut its reimbursement to out-of-networok surgery centers by about 80 percent, said Leigh Martin May, attornegy with the plaintiff’s . Blue Cross “has slashed reimbursement ratesto non-member surgery centers making it impossible for theird insureds to receive the benefits they are paying May said. “[The insurer] is charging for a service it haseffectivelgy eliminated. BCBS should honor the contracts they have made withtheirt insureds.
” Plaintiffs are seeking monetary damagees -- which, May said, coule run into the “eight figures” -- for Blue Cross Georgia’es alleged failure to pay the contracte reimbursement rate and they are asking the courft to force Blue Cross Georgia to honor its Earlier this year, Tenn.-based National Renal Alliance filede a lawsuit against Blue Cross Georgia, claiming the insure slashed reimbursement rates for out-of-network dialysis serviceds by 88 percent. National Renal Alliancee was acquired by RenalAdvantage Inc.
last In March, a federal court judg e in Atlanta dismissedthe suit, saying Blue decision to amend its reimbursement rates for dialysis performed at out-of-networi facilities like the Alliance’s did not violate the act’s provisions that prohibitr insurers from discriminating against individuale with end-stage renal