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Providers Sue Over Rates

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Georgia surgery centers have filed a federal court suit against a Georgia health carrier.

The surgery centers allege that Blue Cross Blue Shield of Georgia, Atlanta, a unit of WellPoint Inc., Indianapolis, has been paying centers only a fraction of the actual cost of procedures when Georgia Blue plan members go to the centers for out-of-network care.

The plaintiffs, represented by Butler, Wooten, and Fryhofer, Atlanta, and J. Tom Morgan of Decatur, Ga., say members of the Georgia Blue health plan paid a higher premium to get coverage for out-of-network care.

Georgia Blue imposed immoderate reimbursement cuts on out-of-network providers, reducing payments to only a small portion of the centers’ normal charges, the plaintiffs allege.

According to the suit, Georgia Blue’s actions violate the company’s own contracts as well as federal and state patient protection laws.

The suit names Blue Cross Blue Shield Healthcare Plan of Georgia Inc. and Blue Cross and Blue Shield of Georgia Inc. as defendants. The plaintiffs are seeking monetary damages and injunctive relief.

The case is pending before Judge Ashley Royal of the U.S. District Court in the Middle District of Georgia, Macon Division.

Georgia Blue is rejecting the plaintiffs’ allegations.

“The allegations in the complaint are without merit, and Blue Cross and Blue Shield of Georgia intends to defend the suit vigorously,” Georgia Blue representative Cheryl Monkhouse says in a statement.

“BCBSGA is committed to providing appropriate reimbursement for out-of-network services, while at the same time protecting its members and group customers against excessive charges by some non-participating providers,” Monkhouse says. “BCBSGA believes that it appropriately reimburses providers who do not participate in BCBSGA’s networks for the services they provide to BCBSGA members.”


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