Tustin, Calif.-based Orange County Multispecialty Surgery Center is suing Blue Cross and Blue Shield of North Carolina for allegedly paying only a fraction of its patients' bills, the Triangle Business Journal reported Sept. 1.
According to the suit, a patient received surgery at the center in 2018 after a Blue Cross NC employee allegedly represented to the patient that the surgery would be reimbursed.
The bill of more than $191,000 was not fully paid, according to the suit, and instead the insurer paid just over $1,300.
In the suit, the OC Multispecialty Center points to a standard practice where some providers enter into a "written preferred provider contract" with a payer. With this contract, providers agree to accept discounted reimbursement in exchange for the benefits of being a preferred provider, which typically include an increased volume of business.
The center claims in the suit that it does not have that relationship with the insurer, according to the Business Journal, and thus has "no obligation to reduce its charges."
The center alleges that the reason it hasn’t entered into a contract with Blue Cross NC is because its contracted rates for in-network providers are "meager, one-sided and onerous."
Durham-based Blue Cross NC declined to comment to the Business Journal through a spokesperson because of a policy that it does not respond to questions about pending litigation.
The insurance company has not yet filed a response to the suit, which the OC Multispecialty Center brought in May.