RALEIGH, N.C. (AP) - A physician's advocacy group has charged in a lawsuit that Blue Cross and Blue Shield of North Carolina harmed doctors with unfair business practices that deny and delay payments for medical care.
The lawsuit, which the North Carolina Medical Society filed in Wake County Superior Court on Monday afternoon, is similar to national legal challenges against Aetna U.S. Healthcare, Cigna Healthcare and other national for-profit insurers.
"We want Blue Cross to start playing by the rules and start treating doctors fairly," said Robert Seligson, executive director of the society, which represents 11,000 physicians in the state.
Last March, Aetna agreed to pay $170 million to settle a class-action suit by 700,000 doctors who alleged unfair business practices.
Cigna agreed in September to spend $540 million to correct what physicians said was a pattern of systematically denying and delaying payments.
The state medical society has retained the New York law firm of Milberg Weiss, which participated in the national suits.
The group isn't seeking financial damages for its members from Chapel Hill-based Blue Cross.
The goal, Seligson said, is to quickly secure meaningful changes in how the company processes and pays claims submitted by physicians. Blue Cross spokesman Mark Stinneford said the company had been working with the medical society to address its concerns when a national lawsuit filed in August against Blue Cross plans across the country changed the playing field.
To protect its position in the national case, Blue Cross told the medical society it could continue only if talks were kept confidential, an offer the group declined.
"We are the one insurer that has been willing to talk with physicians about these issues," Stinneford said.
In its 30-page legal complaint, the medical society contends that Blue Cross has withheld "millions of dollars of lawful reimbursement" from physicians in various ways.
The lawsuit says Blue Cross used software programs to automatically deny payment for medical care or substitute a lower-paid procedure for the billed care.
The society also says Blue Cross failed to make payments within 30 days after a claim is received, as required by state law, and requesting "redundant and excessive" medical records in order to delay such payments.
In some cases, Blue Cross has asked for refunds, often for tens of thousands of dollars, as long as seven years after the overpayment was made, according to the medical society.
The medical society has been pressing Blue Cross to change its ways for years. In October 2002, during a hearing on Blue Cross' now-defunct attempt to become a for-profit company, Seligson publicly challenged the company's chief executive, Robert J. Greczyn, to address physicians' concerns.
Medical society staff met several times with Blue Cross representatives last year and produced a preliminary framework for improvement. But it never went beyond the draft stage.
"Just getting that little bit done took over a year, and there just wasn't enough there," said Carol Scheele, an associate general counsel for the medical society.