FRANKLIN, Tenn.—National Renal Alliance said today that it has field a civil complaint against Blue Cross Blue Shield of Georgia for allegedly singling out dialysis benefits and cutting out-of-network reimbursement to the dialysis provider’s Georgia clinics.
The civil complaint against Georgia’s largest private insurance company was filed in federal court in Atlanta. Cindy Sanders, director, corporate communication with Blue Cross Blue Shield of Georgia, said the insurance company has not yet been served with the suit and can’t comment until it receives the documents.
The complaint alleges that Blue Cross Blue Shield of Georgia have tried to cap the reimbursement it pays for out-of-service dialysis services performed by National Renal.
“By refusing to contract fair rates and slashing payments for out-of-network care to a level 88 percent lower than customarily reimbursed charges, Blue Cross has breached its insurance agreement,” National Renal said in a press release.
National Renal was founded in 2002 and owns and operates 43 dialysis clinics in the United States.
“The impact of these cuts will be devastating to our clinics and for the patients who rely on us for life-sustaining care,” Joe Cashia, National Renal CEO, said in a statement. “Blue Cross is forcing us to close our doors to these patients, and possibly close our doors completely.”
In the press release, National Renal said Blue Cross Blue Shield has violated federal law by targeting dialysis patient’s Medicare eligibility or differentiating the benefits it provides.
“Dialysis is unique because it is the only medical condition where commercial payers like Blue Cross are only required to provide medical coverage to dialysis patients for up to 30 months,” Cashia said. “It seems that Blue Cross wants to escape its obligation early by forcing these patients into restrictive networks, where Blue Cross can take their money but pay less for the care they receive.”
Currently, private insurance companies pay for the first 30 months of a patient’s dialysis treatment. After that time, Medicare steps in to pay, at a rate much less than what private insurance often pays. National Renal, however, said that many dialysis patients choose to pay higher premiums for preferred provider organization (PPO) and point of service (POS) health plans in order to choose which clinic they want to go to for treatment.
National Renal said they provided details in the complaint of how Blue Cross allegedly continued to market and sell PPO and POS plans at higher premiums while providing benefits similar to less expensive HMO plans. “As a result, many [patients] will be forced to drive further distances to receive care at clinics that are in the Blue Cross network,” National Renal wrote in the press release.
National Renal said it is continuing to work with Blue Cross Blue Shield to resolve the complaint. “We had no choice but to file this complaint on behalf of our patients and on behalf of every single dialysis patient who wants to receive quality care from the caregiver of their choice,” Cashia said in a statement. “We will not stand by and allow Blue Cross—part of one of the biggest, most profitable insurance conglomerates in the country—to target these sick, vulnerable people.”