Hospitals sue BCBS of Georgia for sending ED reimbursements to patients


Two hospitals in Georgia and California are individually suing Blue Cross and Blue Shield of Georgia for sending reimbursement money for emergency department care directly to patients, Kaiser Health News reported.

The two out-of-network hospitals — Polk Medical Center in Cedartown, Ga., and Martin Luther King, Jr. Community Hospital in Los Angeles — argue sending ED reimbursement money to patients comes at a cost to the hospitals. Each suit also claims some patients are purposefully profiting off the reimbursements, as not all patients use the money to pay back the hospitals.

Polk claims BCBSG implemented the new payment process in "retaliation" for the hospital's refusal to reach an agreement with the insurer, Kaiser Health News reported. An attorney representing Polk said the payments have been going on for several months.

MLK makes similar claims in its lawsuit filed June 2, saying the payment process is a means to force out-of-network hospitals into signing contracts with unsatisfactory reimbursement terms. According to the lawsuit, BCBSG paid one patient more than $70,000 for 11 ED visits from October 2015 to March 27.

Another hospital unaffiliated with the lawsuits — Grady Memorial Hospital in Atlanta — said it also had trouble getting payments from BCBSG when it was out of the insurer's network for four months through March 2015. 

BCBSG declined comment, citing pending litigation, Kaiser Health News reported.


Copyright © 2021 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars