BCBS of Georgia hit with bicoastal lawsuits for ER payments

emergency room sign

Two hospitals on opposite sides of the country are suing Blue Cross Blue Shield of Georgia (BCBSGA), claiming the insurer is sending reimbursement for emergency room care to patients rather than providers, according to Kaiser Health News.

A lawsuit filed earlier this month by Martin Luther King Jr. Community Hospital (MLK) accuses the insurer of issuing payments to patients as a “retaliatory tactic” against the hospital for refusing to enter into a contract that would make them an in-network provider.  Although MLK requires patients to sign a contract authorizing all insurance payments to the hospital, many patients are “unaccustomed to receiving payments in such large amounts” and are unaware they are required to endorse the checks to MLK.

“When MLK attempts to collect the amounts from these patients, the money is often spent,” the complaint reads. The hospital is seeking $350,000 in damages.

Polk Medical Center in Georgia is suing BCBSGA for the same practice, also accusing the insurer of retaliating against the provider for not agreeing to be an in-network provider.  Tommy Manning, an attorney for Polk's parent system Floyd Medical Center, told KHN that BCBSGA had been directing reimbursement to patients for several months, depleting the hospital’s finances.

Daron Tooch, the attorney for MLK, added that this is a common tactic used by BCBSGA since it’s often difficult for hospitals to recoup the money from patients.

“This is not unique to MLK,” Tooch told KHN. “This happens to all out-of-network providers for Blue Cross of Georgia.”

A recent poll conducted by the American College of Emergency Physicians found that most ER physicians say patients don’t know what their policies cover for emergency care.

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