Two Chicago outpatient surgery centers, part of American Health Care Centers, allege that Blue Cross & Blue Shield of Illinois reneged on "unambiguous promises" of coverage for services, according to a Crain's Chicago Business report.
Fullerton Kimball Medical & Surgical Center is seeking $9.9 million in fees for more than 1,100 services given between 2007 and 2011, according to the report. Western Diversey Surgical Center is seeking $595,000 in fees for more than 110 services given between October 2010 and September 2011.
Fullerton Kimball is out-of-network with Blue Cross but allegedly verified with Blue Cross that the insurer would pay its fees before providing any medical care, according to the complaint. The clinic relied on the verification and decided not to directly bill Blue Cross members at the time of service.
Since the services were rendered, Blue Cross has allegedly refused to pay the surgery center's claims, according to the report. Western Diversey made similar allegations about claims submitted after March 2010, when the surgery center terminated its contract with Blue Cross.
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Fullerton Kimball Medical & Surgical Center is seeking $9.9 million in fees for more than 1,100 services given between 2007 and 2011, according to the report. Western Diversey Surgical Center is seeking $595,000 in fees for more than 110 services given between October 2010 and September 2011.
Fullerton Kimball is out-of-network with Blue Cross but allegedly verified with Blue Cross that the insurer would pay its fees before providing any medical care, according to the complaint. The clinic relied on the verification and decided not to directly bill Blue Cross members at the time of service.
Since the services were rendered, Blue Cross has allegedly refused to pay the surgery center's claims, according to the report. Western Diversey made similar allegations about claims submitted after March 2010, when the surgery center terminated its contract with Blue Cross.
Related Articles on Coding, Billing and Collections:
11 Statistics on Most Payor Coverage Denials
New York Senate Approves Bill to Prevent Surprise Medical Bills
20 Recent Medicare, Medicaid Issues