Blue Cross Pays Doctors for Being Short-Changed

Brent Adams

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A group of Miami, Florida doctors sued twenty-three Blue Cross and Blue Shield Plans, as well as the Blue Cross and Blue Shield Association, because they alleged they had been systematically cheated by these insurance companies when the doctors filed claims for medical services.

The doctors allege that the insurance company programmed their computers to pay for less expensive services than were actually provided. The result was that the doctors were short-changed for their services.

The insurance companies recently agreed to settle the doctors' claims by paying $128,000,000.00 in the class action suit filed by the doctors. The suit filed by the Miami, Florida doctors as a class action included approximately 900,000 physicians across the country who were affected the alleged unfair payment practices by the Blue Cross related companies. In addition, the insurance companies will pay up to $49,000,000.00 for legal fees which will be set by the court.

In recent years, insurance companies have become more and more involved in the practice of medicine by trying to dictate to doctors the procedures they should give to their sick patients and the fees for those services. Doctors complain that they cannot practice medicine independently and are hampered by insurance companies who look over their shoulders and dictate how they should practice medicine.

The suit described above by the doctors shows that insurance companies are not above the law. There is a remedy for insurance companies which attempt to cheat doctors and patients by willfully failing to pay what is fair and what is called for under the terms of the policy.

Insurance companies which act in bad faith in failing to pay the appropriate amount due under health insurance policies could be subject to North Carolina statutes which require insurance companies to practice fair claim procedures in handling their claims. Penalties against the insurance company for failure to exercise good faith claim settlement practices could be subject to treble damages (payment of three-times the amount of the claim) plus attorney's fees.

If you feel that you have been treated unfairly by your health insurance company, which has failed to pay the claims due under the terms of your policy, please fill out the Injury Board form on this page. A lawyer will call you and see if they can help you with your claim.