Medical clinics sue Blue Cross in dispute over insurance rates

[private]A group of 11 surgery centers and medical clinics is suing Blue Cross and Blue Shield of Georgia, the state’s largest health insurer, over allegations that Blue Cross is overcharging policyholders who seek treatment from out-of-network healthcare providers.

The lawsuit charges that Blue Cross and its parent company, Anthem Inc., are engaging in fraud, unfair trade practice, misrepresentation, and breach of contract by charging higher premiums for policyholders who go to an out-of-network provider rather seek treatment from in-network providers that negotiate lower rates with the insurers.

The clinics are represented by John Oxendine, who was the state insurance commissioner for 16 years before running unsuccessfully for governor in 2010. They are asking for a jury trial, certification as a class action lawsuit, and an unspecified amount of compensatory damages.

Blue Cross and Anthem disputed the lawsuit’s allegations.

“Blue Cross and Blue Shield of Georgia does not discuss the details of pending litigation,” spokesperson Debbie Diamond said.

“Nevertheless, the allegations are unfounded,” she said. “Further, we believe these surgery centers were properly compensated for their services. Our goal at all times is to serve the best interests of our customers, ensuring that they have access to the best, most advanced health care available.”

The lawsuit was filed Monday in White County Superior Court in Cleveland. No hearing dates have been scheduled yet.

“We’ve been in discussions with them (Blue Cross’s lawyers) since the end of April, the first of May,” Oxendine said. “We tried to resolve it without litigation, but that wasn’t successful, obviously.”

A spokesperson for the current insurance commissioner, Ralph Hudgens, indicated the office will review the allegations contained in the lawsuit.

“We knew nothing about this until he (Oxendine) filed the lawsuit Monday,” said Laura Wright. “We’re going to absolutely take a look at it.”

“We can always take a look at a company’s market behavior,” Wright said. “We always want to make sure the insurance companies are acting properly.”

The plaintiffs suing Blue Cross are ALLIANCEMED, Surgery Center of BJI, ENTI Surgery Center, ENTI Anesthesia, Urological Clinic of Valdosta Ambulatory Surgical Center, Savannah F&A ASC, Institute for Corrective Surgery of the Foot and Ankle, Westside Surgery Center, Surgical Centers of Georgia, Roswell Center for the Foot and Ankle Surgery, Ambulatory Foot and Leg Surgical Center, and East Cobb Podiatry Surgery Center.

Blue Cross has been involved in contentious disputes before with healthcare providers and physicians.

Last year, the insurance giant squabbled with Grady Health System after their contract lapsed in late November. This meant that Grady Memorial Hospital was “out of network” for several months, which resulted in Blue Cross health plan members paying higher out-of-pocket costs if they were treated at Grady.

Grady and Blue Cross finally resolved their long-running payment dispute in March.

© 2015 by The Georgia Report

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Tags: Anthem , Blue Cross , insurance premiums , John Oxendine , out-of-network providers