According to Courthouse News, a federal RICO complaint accuses Blue Cross/Anthem of a wide-ranging deceptive scheme to underpay claims from out-of-network hospitals. Methodist Hospital of Southern California claims Blue Cross refuses to let it transfer patients from emergency rooms, then underpays the hospital and sticks patients with hefty bills, claiming the patients "requested" to stay put, though it was Blue Cross that made the decision.
The scheme follows a well established pattern, according to the hospital, which quit the Blue Cross network in 2008, citing low payback rates that were "onerous and one-sided in favor of Blue Cross."
The hospital is still required by law to treat any Blue Cross patient brought to its emergency room with life-threatening injuries. After the patient is stabilized the hospital must call Blue Cross to ask if it wants the patient transferred to an in-network hospital.
In nearly every instance, the hospital says, Blue Cross refused to transfer the patient to an in-network hospital, then underpaid the Methodist Hospital for care, in wildly fluctuating amounts, sticking the hospital and the patient with an unfair financial burden. |
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