Tuesday, February 19, 2008 - 12:21 PM EST
National Renal Alliance files another complaint against Blue Cross and Blue Shield of GeorgiaAtlanta Business Chronicle - by Urvaksh Karkaria Staff Writer
National Renal Alliance on Tuesday filed an amended civil complaint against Blue Cross and Blue Shield of Georgia, the state's largest private insurance company. The amended complaint, filed in federal court in Atlanta, detailed the "insurance company's manipulation of usual and customary charges to deny dialysis patients their out-of-network benefits," National Renal said in a statement.
On Jan. 15, the Nashville, Tenn.-based dialysis provider filed a lawsuit against Blue Cross, after the insurer slashed reimbursement rates for out-of-network dialysis services by 88 percent.
The lawsuit is seeking compensatory damages and asking Blue Cross be ordered to reinstate reimbursement rates to its original level.
Blue Cross, in an e-mail, said its position is unchanged by National Renal's amended complaint. The insurer added the suit is without merit.
"NRA is a non-participating dialysis provider who, to the best of BCBSGa's knowledge, currently provides dialysis services to approximately 20 BCBSGa members who have out-of-network benefits," the e-mail said. "Their current benefits and access to NRA clinics will not change because of this lawsuit, absent NRA's refusal to accept them as patients."
In the amended complaint, National Renal provides details of how "Blue Cross is continuing to market and sell Preferred Provider Organization, and Point of Service health plans in exchange for higher premiums while intentionally undermining their members' ability to receive the benefit of these plans".
"Blue Cross is engaging in deceptive and potentially confusing trade practices," the statement noted.
The result of Blue Cross' actions is that their members are denied the very flexibility they are paying for and are simply paying higher premiums to receive benefits identical to those under cheaper, traditional HMO plans, National Renal claims.
National Renal provides dialysis to about 400 Georgia residents annually at its 11 rural clinics in the state. Blue Cross members account for about 6 percent of the private company's Georgia patients.
Under the reduced reimbursement structure, National Renal receives 12 cents for every dollar of care it provides to Blue Cross members, National Renal CEO Joe Cashia has said in a previous statement.
"The impact of these cuts will be devastating to our clinics and for the patients who rely on us for life-sustaining care," he said in January. "Blue Cross is forcing us to close our doors to these patients, and possibly close our doors completely."
http://www.bizjournals.com/atlanta/stories/2008/02/18/daily12.html
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