BlueCross BlueShield of Tennessee Works To Dismiss or Delay Medical Association Lawsuit
BlueCross BlueShield of Tennessee on May 28 filed documents in Davidson County Chancery Court claiming that lawsuits filed against it by the Tennessee Medical Association and several individual physicians are not justified and asked a judge to delay or dismiss the suits, the Nashville Tennessean reports (Lewis, Nashville Tennessean, 5/30). Last month, the TMA and three individual physicians filed suit against the state's four largest health insurers for alleged "unfair and deceptive business practices that harm physicians" and patients. The suit names Aetna Inc., BlueCross BlueShield of Tennessee, United Healthcare Inc. and Cigna Healthcare of Tennessee -- which account for 70% of the state's HMO market -- as defendants, and seeks a court order to end several "wrongful and financially punitive" business practices that the health plans allegedly use to "delay, deny or reduce payments to physicians." The allegations include denying reimbursements to physicians for "medically necessary" care; reimbursing physicians for less expensive procedures than they performed; reimbursing physicians for a single service when they have performed a number of procedures; and using computer software to "automatically reduce or deny" reimbursements to physicians without reviews from health plan employees (Kaiser Daily Health Policy Report, 4/26). Aetna, United Healthcare and Cigna Healthcare were not involved in BlueCross BlueShield's filing, according to company spokesperson Frances Hamman-Prewitt. Ron Harr, senior vice president of Blue Cross, said, "We vigorously deny the allegations against us." Harr noted that the individual doctors suing his company never appealed any claims using the company's internal appeal procedures, and questioned why the TMA would file a lawsuit instead of submitting its claims for arbitration. TMA spokesperson Russ Miller said TMA would like a court to decide if the insurers are complying with their contracts. Miller said, "This is about fairness. This isn't about health care costs. This isn't about arbitration" (Nashville Tennessean, 5/30).
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