ATLANTA (CN) – Blue Cross and Blue Shield of Georgia’s motion to compel arbitration will be heard in Fulton County Superior Court on Dec. 2. Physicians who operate as Northeast Georgia Cancer Care accuse the insurer of arbitrarily lowering reimbursement rates for numerous cancer infusion drugs, services and procedures.
The plaintiffs sued in September, saying Blue Cross failed to respond to complaints about the 2007 PPO contract and Participating Physician Agreement filed with the defendant’s Provider Appeals department.
In October, Blue Cross sought to compel arbitration and to dismiss the complaint or stay proceedings pending arbitration. It claims the doctors circumvented the arbitration process by filing the lawsuit.
“Under the terms of the NEGCC Provider Contract the parties are required to submit disputes to arbitration as a means of reaching resolution,” said Cheryl Monkhouse, Blue Cross and Blue Shield of Georgia director of Public Relations. “NEGCC did not comply with its contractual obligations before filing the current lawsuit.”
Loretta Goodson, practice administrator with Northeast Georgia Cancer Care, disagrees.
“We took the steps that Blue Cross and Blue Shield recommended and they failed to respond,” Goodson said. “We hope the judge will decide to allow us to pursue our suit. We want this to be resolved.”
Goodson added that the arbitration is non-binding and they are free to pursue the lawsuit if a resolution cannot be reached.
On Oct. 31, the plaintiffs filed an amended complaint to dispute a 2007 HMO contract in addition to the 2007 PPO contract and the Participating Physician Agreement originally disputed in the first complaint. The issues in the original complaint will heard in the hearing; if time allows, the issues in the amended complaint will be addressed as well, Goodson said.
The same parties have a similar lawsuit pending before the Georgia Court of Appeals, and Goodson expects a decision to be made in that case by the end of the year. Reimbursement rates for oncology contracts are disputed in this lawsuit, filed in 2007 in Clarke County Superior Court. This dispute led to Northeast Georgia Cancer Care being left out of the HMO network for medical oncology. It says many cancer patients were forced to drive long distances for care.
The doctors are represented by James W. Boswell with King & Spalding.