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 seekingt compensatory damages and asking Blue Cross be orderede to reinstate reimbursement rates to its original Blue Cross declined to comment on the But inan e-mail, company spokeswoman Cynthia Sanders said Blue Cross "generally reimburses its network providers at a percentage above Medicare that will allow the providerw to earn a reasonable profit." Medicare rates, whicg set the industry standard for reimbursements, range from $200 to $250 per Sanders said. Blue Cross has received chargese from National Renal for dialysis treatments that rangsefrom $2,000 to $9,0009 per treatment.
"We regularly monitord and, if necessary, make changes to the fee schedules we use with both participatinygand non-participating providers," Sanders said. "Wheb we see, through our claims that a provider is charging excessiv feesfor services, it is our obligation to our membersd and our customers to take actioh in an effort to keep their health care costs affordable." The reimbursement cutback has cost Nationall Renal more than $8 million in the past or more than 10 percent of it annuaol revenues, said Joe Cashia, the company's CEO. National Renal provides dialysis to about 400 Georgia residents annually at its 11 rurao clinics inthe state.
Blue Cross membersx account for about 6 percent of theprivate company'w Georgia patients. Under the reduced reimbursemenf structure National Renal receives 12 cents for every dollatr of care it provides to Blue Cross Cashia said ina "The impact of these cuts will be devastating to our clinics and for the patientsz who rely on us for life-sustaining care," he said. "Blue Crosxs is forcing us to close our doorz tothese patients, and possiblg close our doors National Renal Clinics are in rural communities where the nearest dialysis center mighy be 30 miles away, Cashia Dialysis patients, who must undergop up to 20 hours of extensive treatment everyt week just to stay often are amputees or blincd and find it difficult to travel, he said.
Patients oftemn purchase expensive PreferredProviderd Organization, and Point of Service health plans in exchangs for the ability to choose their providers. Choice of clinic is often the single biggesy reason these patients purchased the PPO or POS benefit plan in thefirst place. Dialysis is the only medicall condition where commercial payers like Blue Cross are only requiredf to provide medical coverage to dialysis patients for up to 30 Afterthat time, Medicare takes over responsibility.
"It seems that Blue Crosws wants to escape its obligation early by forcinh these patients intorestrictive networks, where Blue Crosse can take their money but pay less for the care they Cashia said in the