North Carolina Blues sued over pay methods

The state medical society filed suit, charging that the insurer uses unfair practices.

By Tanya Albert, AMNews staff. Jan. 26, 2004.

The North Carolina Medical Society is asking for the state court's help in changing the way BlueCross BlueShield of North Carolina does business with doctors. NCMS on Jan. 5 filed a lawsuit in Wake County Superior Court accusing the North Carolina Blues plan of using unfair and deceptive practices to delay, deny or reduce physician reimbursements.

The lawsuit is similar to class-action lawsuits filed in federal courts that accuse the nation's largest insurers of unfair business practices, such as bundling and downcoding claims and arbitrarily refusing to pay for treatments that physicians provided to health plan subscribers. Aetna and CIGNA HealthCare last year settled lawsuits filed against their companies; a half-dozen other lawsuits are winding their way through the federal court in Miami.

North Carolina physicians say they have worked with insurers for years in an effort to get them to change their practices. They said the state lawsuit is a last resort to bring about changes. In their lawsuit, physicians are asking for changes to the system, not money, said Robert W. Seligson, the medical society's executive vice president and CEO.

"Bottom line, we are trying to have doctors treated with respect so they can be healing instead of dealing," he said.