Dive Brief:
- Martin Luther King Jr. Community Hospital in Los Angeles is suing Blue Cross and Blue Shield of Georgia for paying patients rather than the hospital for emergency services, Modern Healthcare reported.
- The tactic forces the hospital to try to collect payment from the patients, which is often impossible, the hospital said, because some patients either don't understand they owe the money to the hospital or immediately spend it on personal expenses.
- The lawsuit alleges the insurer is intentionally being difficult to force the out-of-network hospital to accept its contract rates and go in-network.
Dive Insight:
The lawyer representing the hospital said it's a broader problem than just this case.
“It's a big issue for all kinds of providers, not just hospitals,” Daron Tooch, partner at Hooper, Lundy & Bookman, told Modern Healthcare.
Tooch plans to file additional lawsuits regarding similar complaints from other hospitals against other insurers.
Aside from the matter of getting patients to pay, Tooch suggested there is abuse of the system, noting at least one of the hospital's patients visited the emergency department a dozen times in 18 months.
Still, Martin Luther King Jr. Community Hospital has stood its ground, complaining rates offered by Blue Cross are too low and their contracts too "onerous and one sided."
David Kaufman, former general counsel for Blue Cross and Blue Shield of Illinois, told Modern Healthcare some insurers do only pay providers directly if they go in-network as a form of enticement, though some states have passed laws requiring payment to providers.