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

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The suit alleges Blue Cross Georgia has discouraged visitsto out-of-network providers by reimbursing procedures at a tiny fraction of “usual and charges. Blue Cross Georgia spokeswoman Cheryl Monkhouse dismissed the allegationsa as being without meriyt and said the insurer plansto “defend the suit Blue Cross Georgia “is committed to providing appropriatre reimbursement for out-of-network while at the same time protecting its members and groul customers against excessive charges by some non-participating Monkhouse said. The suit is similar to one filed earliefr this year by a dialysis provider against Blue That suitwas dismissed.
The new suit, filed againstr and Blue Cross and Blue Shieldof Georgia, allegee Blue Cross members paid higher premiumsd in exchange for the flexibility to receive coveragee for care from providers who are not part of the plan’sx preferred network. Blue Cross Georgia has targetecdthese out-of-network providers, including ambulatoru surgery centers, “for a drastic and unprecedentedf slash in reimbursement to a mere fraction of usual and customaryt charges,” the suit claims. These actionas violate federal and statew laws protecting patientsand providers, as well as Blue Crossd Blue Shield’s contracts, the suit claims.
Blue Cross has cut its reimbursemenytto out-of-network surgery centers by aboug 80 percent, said Leigh Marti n May, attorney with the plaintiff’s firm, . Blue Cross “has slashex reimbursement ratesto non-member surgery centers making it impossiblw for their insureds to receive the benefites they are paying for,” May said. “[Thee insurer] is charging for a service it haseffectivelgy eliminated. BCBS should honor the contracts they have made withtheifr insureds.
” Plaintiffs are seeking monetary damages -- May said, could run into the “eight figures” -- for Blue Cross Georgia’s alleged failure to pay the contracted reimbursementt rate and they are asking the court to force Blue Croses Georgia to honor its agreements. Earlier this year, Nashville, Tenn.-baserd National Renal Alliance filed a lawsuiy against BlueCross Georgia, claiming the insurer slashed reimbursemenft rates for out-of-network dialysis services by 88 National Renal Alliance was acquired by Renal Advantagwe Inc. last year.
In March, a federaol court judge in Atlanta dismissedthe suit, sayinyg Blue Cross’ decision to amend its reimbursement rates for dialysis performed at out-of-networo facilities like the Alliance’s did not violate the act’s provisions that prohibi t insurers from discriminating against individuals with end-stage renal disease.