National Renal Alliance, Franklin, Tenn., has filed a civil lawsuit against Blue Cross and Blue Shield of Georgia, alleging the insurer has violated federal law by attempting to single out dialysis benefits and cut out-of-network reimbursements to National Renal clinics in the state. Filed in U.S. District Court in Atlanta, the complaint asserts that Blue Cross and Blue Shield has refused to contract at fair rates, thereby breaching its insurance agreements.
Blue Cross has targeted the dialysis industry for a drastic and unprecedented slash in reimbursement to a mere 12% of usual and customary charges, the 50-page complaint said. Blue Crosss actions violate federal law protecting dialysis patients and providers from discrimination by commercial payers.
Blue Cross and Blue Shield of Georgia did not comment on the matter because the company had not yet been served with the complaint, said Cindy Sanders, a spokeswoman for the company in Atlanta.
According to the court filing, Blue Cross and Blue Shield of Georgia determined in 2006 that the usual, customary and reasonable charge for National Renals dialysis services was about $2,900 per treatment, an amount that is in line with what National Renal receivedand continues to receivefrom other commercial payers. Then the company cut reimbursement by 88% on Jan. 1, 2007.
Joanne Thornton, a spokeswoman for National Renal Alliance, said the legal action against Blue Cross is limited to the National Renal clinics in Georgia.
Formed in 2002 by dialysis industry executives, National Renal Alliance owns and operates 43 dialysis centers across the U.S. The company partners with local nephrologists and focuses on underserved communities. -- by Jessica Zigmond
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