Some of the suits have been going around for a while since Prime Healthcare purchased the hospital. Prime normally does not sign contracts with insurers although I have heard that this could have changed in a few instances. At any rate this is a mess once again. Without a contract, a Prime Hospital can charge their normal and customary rates and the insurers with emergency care are supposed to pay. Prime in the past sued Blue Cross for supposedly telling patients to go elsewhere for care. Walmart and Blue Cross/Blue Shield are also named in one of the lawsuits for failure to pay the patient’s claims.
The WalMart suit stated the hospital is owed just short of $3 million and it received only $477,000. Question I ask at this point is this what other hospitals get paid since so many are having financial difficulties. So far Shasta has not entered into an agreement with Blue Cross/Blue Shield and that seems to be the sticking point here with wanting to pay less. BD
Shasta Regional Medical Center has filed at least 18 new lawsuits alleging out-of-state Blue Cross, Blue Shield and Anthem health insurance providers owe the hospital millions in unpaid medical bills.
The suits are the latest legal salvo in a contentious and long-running battle the hospital and its parent company, Prime Health Care Services, have had with the private insurance companies.
Hospital CEO Randall Hempling said patients who use the hospital's emergency room will continue to be seen by a doctor, and they shouldn't worry about being sued.
"For emergency care, the plans can't deny them access," Hempling said.
The insurers counter the hospital continues to overbill patients.
Blue Cross considers Prime to be out-of-network, and because there's no payment structure set up between the groups, patients who have out-of-state Blue Cross or Blue Shield plans get their reimbursements from the insurer in a check directly written to them
The insurer has countered patients are put in the situation because the hospital refuses to enter into an agreement with the insurer that would make Blue Cross an in-network provider and negate the need for the insurer to issue checks directly to patients.