A proposed class action that alleges ACS Primary Care Physicians-Southeast, P.C. has unlawfully refused to process or submit bills arising from motor vehicle accidents for those insured under existing Blue Cross Blue Shield Insurance Company (BCBS) policies in South Carolina.
According to the 14-page lawsuit, the defendant is a preferred provider in the BCBS network and has previously agreed to accept scheduled payment rates for BCBS insureds or members as a condition of its preferred provider status. Per the lawsuit, the plaintiff and proposed class members are third-party beneficiaries to the defendant’s preferred provider contract with BCBS who are therefore subject to the rates stipulated by the agreement.
The complaint alleges ACS’s decision to refuse to submit proposed class members’ claims to BCBS was based on monetary gain in that the defendant was able to increase its cash flow by charging insureds for the full price of medical services rather than the contractually agreed upon cost for BCBS members. In all, ACS’s conduct is in violation of its BCBS contract and has deprived the plaintiff and proposed class members of the benefit of their insurance coverage, the lawsuit says.
Per the complaint, the plaintiff was involved in a December 2019 car accident in which she sustained serious injuries treated at the Grand Strand Regional Medical Center. At the time of the collision, the plaintiff was insured by BCBS, the suit says.
Despite the contractual relationship between the defendant and BCBS, ACS and its representatives “refused” to submit the plaintiff’s bills related to the vehicle collision to the insurer, the case claims, noting that car accident medical claims stemming from emergency room care “represent the worst performing revenue streams for a hospital.”
By refusing to accept insurance coverage for car accident injuries, ACS can generate “a significant increase in cash flow” by receiving payment immediately and directly from patients in amounts far in excess of the rates negotiated with BCBS, the lawsuit alleges. Per the case, the plaintiff was billed more than $1,600 for treatment demanded in full by the defendant.
The lawsuit looks to represent:
“All persons (or estates of persons) in South Carolina or persons (or estates of person) [sic] who have jurisdiction with a South Carolina Court under the Door Closing Statute insurance by BCBS receiving services from Defendant in any medical facility from December 9, 2016 to present for whom Defendant failed to submit the bill for medical services to BCBS and instead obtained recovery from the person.”
Initially filed in the Horry County Court of Common Pleas, the case has been removed to South Carolina District Court, Florence Division.
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