Medical Center suit alleges big underpayments from Blue Cross

awomack@macon.comFebruary 27, 2013 

The Medical Center of Central Georgia has filed suit against Blue Cross Blue Shield of Georgia, contending that the insurance company has underpaid the hospital by more than $22 million.

Of the underpayments, the hospital alleges that $1,191,254 in reimbursements owed are related to cardiac catheterization procedures from 2011. Another $2,240,369 is owed from claims involving babies who were healthy upon delivery dating to December 2009, according to the lawsuit, filed Friday in Bibb County Superior Court.

The hospital contends that the insurance company breached agreements. After a 2010 audit, the Medical Center wrote to Blue Cross seeking payment, and the insurance company denied any underpayments, according to the court filing.

Several letters were exchanged between the hospital and Blue Cross, culminating in a legal demand letter -- a prelude to a lawsuit -- mailed by the hospital’s lawyer in December 2012.

A lawyer for the insurance company responded, again denying that it owed any money to the hospital and denying liability for the cardiac catheterization and “well-baby” issues.

The Atlanta law office representing Blue Cross Blue Shield declined comment Wednesday, saying “It is our policy not to comment on pending matters.”

The Medical Center declined comment on the lawsuit, but did say the hospital will continue providing health care services to patients covered by Blue Cross Blue Shield plans, said Megan Allen, a hospital spokeswoman.

The hospital has requested a trial by jury, more than $22 million and payment of attorneys’ fees.

To contact writer Amy Leigh Womack, call 744-4398.

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