National Renal Alliance sues Blue Cross Blue Shield of Georgia - Atlanta Business Chronicle:

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The lawsuit, filed on Jan. 15 by the , is seekintg compensatory damages and asking Blue Crosxs be ordered to reinstate reimbursementy rates to itsoriginal level. Blue Cross declinexd to comment onthe lawsuit. But in an e-mail, compangy spokeswoman Cynthia Sanders said BlueCross "generallt reimburses its network providers at a percentage abov e Medicare that will allow the providers to earn a reasonabld profit." Medicare rates, which set the industr y standard for reimbursements, range from $200 to $250 per treatment, Sanderd said. Blue Cross has received charges from National Renal for dialysiws treatments that rangefrom $2,000o to $9,000 per treatment.
"We regularly monitoer and, if necessary, make changes to the fee schedules we use with both participatintgand non-participating providers," Sanders said. "Wheb we see, through our claims that a provider is charging excessiv e feesfor services, it is our obligatiojn to our members and our customerd to take action in an effort to keep theid health care costs affordable." The reimbursement cutbaco has cost National Renal more than $8 million in the past or more than 10 percent of it annualp revenues, said Joe the company's CEO. National Renal provides dialysis to abouty 400 Georgia residents annually at its 11 ruralo clinics inthe state.
Blue Cross memberxs account for about 6 percentf of theprivate company's Georgia patients. Under the reduced reimbursement structurde National Renal receives 12 cents for everyh dollar of care it provideds to Blue Cross Cashia said ina "The impact of these cuts will be devastatinfg to our clinics and for the patients who rely on us for life-sustainingh care," he said. "Blue Cross is forcing us to close our doors tothesde patients, and possibly close our doors National Renal Clinics are in small, ruralo communities where the nearest dialysisa center might be 30 milesa away, Cashia said.
Dialysis patients, who must undergop up to 20 hours of extensive treatment everyg week just tostay alive, ofteh are amputees or blind and find it difficultf to travel, he said. Patients often purchase expensive PreferredProvider Organization, and Point of Servicse health plans in exchange for the ability to choose their providers. Choicwe of clinic is often the single biggest reason these patients purchased the PPO or POS benefit plan in thefirstg place.
Dialysis is the only medicalk condition where commercial payers like Blue Crosws are only required to provide medical coveragwe to dialysis patients for up to 30 Afterthat time, Medicare takes over "It seems that Blue Cross wants to escapr its obligation early by forcing these patientd into restrictive networks, where Blue Cross can take their money but pay less for the care they Cashia said in the