ST. LOUIS (CN) – Anthem Insurance Companies and Blue Cross and Blue Shield are among a handful of insurance companies that fail to fully reimburse health providers for their services, two providers claim in Federal Court.
Midwest Special Surgery and Outpatient Surgical Services claim that, beginning in 2008, the insurers conspired to reduce payments to non-participating health-care providers, or the providers that don’t have contracts with the defendants.
The defendants allegedly used their economic clout to force the plaintiffs to accept reimbursements well below the “usual and customary rate,” defined as the average rate for similar services within a certain region. The defendants have also rejected Outpatient Surgical’s requests for facility fees, the lawsuit claims.
The plaintiffs say the defendants’ actions make it impossible for them to provide the kind of care patients require.
They seek damages and an injunction, and are represented by Michael Sudekum.
Defendants include RightChoice Managed Care, HMO Missouri, Healthy Alliance Life Insurance Company and the WellPoint Companies.