Blues plans sued for out-of-network fees

Outpatient surgery centers are suing Blue Cross Blue Shield of Illinois in two separate lawsuits for reneging on "unambiguous promises" of coverage totaling more than $10 million for various services, Crain's Chicago Business reported. In one lawsuit, Fullerton Kimball Medical & Surgical Center said it's owed $9.9 million in fees for about 1,000 services provided from 2007 to 2011. In the other suit, Western Diversey Surgical Center wants to collect $595,000 for more than 110 services rendered between October 2010 and September 2011. As an out-of-network provider, Fullerton Kimball received verification from Blue Cross that it would pay fees, choosing not to directly bill Blue Cross members at time of service. However, because Blue Cross refused to pay the claims, the surgery centers allege that the verification "constitutes Blue Cross's unambiguous promise to pay the provider for the service" under Illinois law. Article

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