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

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The suit alleges Blue Cross Georgia has discouraged visiteto out-of-network providers by reimbursing procedurea at a tiny fraction of “usuapl and customary” charges. Blue Cross Georgiqa spokeswoman Cheryl Monkhouse dismissed the allegations as beinh without merit and said the insurerr plansto “defend the suit Blue Cross Georgia “is committefd to providing appropriate reimbursement for out-of-networj services, while at the same time protecting its membera and group customers against excessive charges by some non-participating Monkhouse said. The suit is similadr to one filed earlier this year by a dialysi provider againstBlue Cross.
That suit was The new suit, filed againsgt and Blue Cross and Blue Shieldof Georgia, allegez Blue Cross members paid higher premiums in exchange for the flexibilityg to receive coverage for care from providersw who are not part of the plan’d preferred network. Blue Crossw Georgia has targetedthese out-of-networo providers, including ambulatory surgery centers, “for a drastic and unprecedented slash in reimbursement to a mere fraction of usual and customarg charges,” the suit claims. These actions violate federak and state laws protecting patientseand providers, as well as Blue Cross Blue Shield’s the suit claims.
Blue Cross has cut its reimbursementto out-of-networo surgery centers by about 80 percent, said Leigh Martin May, attorneu with the plaintiff’s . Blue Cross “has slashed reimbursement ratedsto non-member surgery centers making it impossible for their insureds to receivd the benefits they are paying May said. “[The insurer] is charging for a servicr it has effectively BCBS should honor the contracts they have made withtheirr insureds.
” Plaintiffs are seekinh monetary damages -- which, May could run into the “eight -- for Blue Cross Georgia’s alleged failurew to pay the contracted reimbursement rate and they are askingb the court to force Blue Cross Georgia to honord its agreements. Earlier this year, Nashville, Tenn.-based National Renal Alliances filed a lawsuit againstf BlueCross Georgia, claiminfg the insurer slashed reimbursement ratesx for out-of-network dialysis services by 88 percent. Nationapl Renal Alliance was acquirexd by RenalAdvantage Inc. last year.
In a federal court judgs in Atlanta dismissedthe suit, saying Blue Cross’ decisionh to amend its reimbursement rates for dialysis performee at out-of-network facilities like the Alliance’s did not violates the act’s provisions that prohibit insurera from discriminating against individuals with end-stages renal disease.