Georgia Health Insurer Accused Of Unfair Practices

A lawsuit has been filed by Georgia surgery centers against Blue Cross Blue Shield Healthcare Plan of Georgia Inc. and Blue Cross and Blue Shield of Georgia, seeking class action. The lawsuit, like many others around the country attacks the insurer’s practice of discouraging visits to out-of-network providers by reimbursing procedures at a tiny fraction of “usual and customary” charges.
The suit is similar to one filed earlier this year by a dialysis provider against Blue Cross. That suit was dismissed. The new suit alleges Blue Cross members paid higher premiums in exchange for the flexibility to receive coverage for care from providers who are not part of the plan’s preferred network.
Blue Cross Georgia is alleged to have engaged in the practice of targeted out-of-network providers, including ambulatory surgery centers, for a drastic reductions in reimbursement to a mere fraction of usual and customary charges. The suit alleges these practices violate federal and state laws protecting patients and providers, as well as Blue Cross Blue Shields contracts.
The suit alleges that Blue Cross has cut its reimbursement to out-of-network surgery centers by about 80 percent and reduced reimbursement rates to non-member surgery centers making it impossible for their insureds to receive the benefits they are paying for. Thus, the suit alleges the insurer is charging for a service it has effectively eliminated.
The Plaintiffs are seeking monetary damages for Blue Cross Georgia’s alleged failure to pay the contracted reimbursement rate and they are asking the court to force Blue Cross Georgia to honor its agreements.