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BCBS of Texas beats physician lawsuit alleging ER underpayments

6 Dec 2018 4:31 PM | AIMHI Admin (Administrator)

Beckers's Source Article | Highlights Courtesy of Matt Zavadsky

BCBS of Texas beats physician lawsuit alleging ER underpayments

Written by Morgan Haefner

December 05, 2018 

A lawsuit filed by 49 physician groups against Blue Cross Blue Shield of Texas was dismissed Dec. 3, according to Bloomberg Law.

The physicians' lawsuit accused BCBS of Texas of underpaying 250,000-plus claims for emergency medical care. Earlier this year, the health insurer announced a new discretionary ER policy, under which a medical director hired by the insurer reviews claims after the ER visit to determine the reason a patient opted for the ER and if they could have received treatment in a less expensive setting.

In the original lawsuit, the physician groups said BCBS of Texas reimburses out-of-network providers at a rate that violates state law and regulations. The judge's two-page order did not explicitly explain why the case was dismissed, according to Bloomberg Law. The physician groups have 60 days to submit a new complaint with additional supporting facts.

Anthem launched a similar policy in multiple states and has faced harsh criticism as well as numerous lawsuits. A recent report from Sen. Claire McCaskill, D-Mo., found the insurer denied 12,200 claims from members in three states during the second half of 2017 on the grounds the ER visits were "avoidable." However, when patients challenged the denials, Anthem proceeded to reverse itself and pay the claims most of the time.


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