Methodist Hospital Files Two Lawsuits Against Blue Cross

Methodist Hospital in Arcadia has filed two lawsuits against insurance giant Blue Cross; one in Superior Court and the other in federal court. The hospital is claiming that Blue Cross is underpaying for the medical care the hospital provides to patients.  Will Garand, Director of Managed Care at the hospital, stated:

“Methodist Hospital is accusing Woodland Hills-based Anthem Blue Cross and affiliated ABC Life and Health Insurance Co. of engaging in a pattern of refusing to transfer health plan members who show up for care at its ER to an insurer’s network hospital once they’re stabilized.   Instead, Anthem allows Methodist to care for the patient and then drastically underpays the medical claim, leaving the patient with a hefty bill.”

The federal lawsuit claims Anthem affiliates in ten states engage in similar patterns to underpay claims from out-of-network hospitals in a wide-ranging scheme that violates ERISA and racketeering laws. The suit filed in Sacramento Superior Court says Anthem uses “two flawed databases or systems to determine unilaterally what amounts hospitals should charge for their services.”

According to Will Garand, the lawsuit between Methodist Hospital and Anthem Blue Cross “involves to a great extent underpayments for emergency services. Anthem Blue Cross asserts that the hospital’s charges are too high so it disallows certain amounts, often as much as half of a claim’s value. In many cases the disallowed charges become patient liability so Anthem Blue Cross is in effect denying patient benefits. This is what occurred in the New York State lawsuit against Ingenix, a UnitedHealthcare company, for its unsupportable claim discounting practices. Methodist Hospital’s billed charges are lower than other area hospitals so we will have no problem showing that Anthem Blue Cross has no basis for disallowing billed charges and patient benefits.”

“Anthem Blue Cross and its corporate parent Wellpoint in Indiana have grown to the point that they engage in predatory business practices with local hospitals and physicians with impunity. Wellpoint uses California as its profit ATM and does not care if access to health care is disrupted for 100,000 enrollees in the San Gabriel Valley. We are fast approaching two years since the contract terminated and Wellpoint’s negotiators take five months to deliver a proposal. There is no sense of urgency or accountability on their part. Health care reform is one way to stop this corporate giant from continuing to underpay health care providers, deny patient benefits through schemes like retroactive policy rescission, and extract double digit annual insurance premium increases from individuals and small employers.”

In related news, Rep. Adam Schiff held a heated health care town hall meeting in Alhambra last week that showed an almost even split on positions on the  health care reform debate with pro health care reformers “…leaning a little more to our side,” according to Schiff in a recent telephone interview.

Like the town hall meetings all over the country, health care reform is a hot button issue for some. In fact many arguments have broken out and even threats against President Obama and the White House have increased as a direct result of this debate.

Republicans argue that socialism will kill the insurance companies and the care some people receive now as beneficiaries of a good health plan.

What democrats want is a plan for all Americans and permanent residents that covers young and old alike.
This plan, not unlike some plans in other countries such as the UK, Canada, and most of Europe operate wherein everyone is covered, has come under increasing fire from the right-wing. And Great Britain is now fighting back to save its jolly good name.

People in the UK don’t always stand up for their government but once they heard their cousins across the pond were pulling apart the National Health System, a campaign of  Pro NHS was inevitable and has taken on a rare life of its own. The stiff upper-lipped British are no longer standing in the background.

British doctors and nurses saved Kezia Obama (President Obama’s stepmother) when she suffered chronic kidney failure seven years ago.

The 66-year-old, who lives in Bracknell, Berkshire, near London insisted she would never have been able to afford healthcare if she had been in America at the time.

Ms. Obama told the News of the World newspaper:  “It’s very simple: I owe my life to the NHS.”
“If it wasn’t for the NHS I wouldn’t have been alive to see our family’s greatest moment – when Barack became President and was sworn into the White House.”

Republicans have branded the NHS “evil” and “Orwellian” amid a major row over President Obama’s plans for US healthcare reform. The heated rhetoric is unlikely to simmer down anytime soon.

Single-payer is House Resolution 676, introduced by Congressmen John Conyers and Dennis Kucinich, with dozens of co-authors. It also has the backing of 235 labor organizations in 40 states, including 17 AFL-CIO state federations and 60 county/regional central labor councils. Several states, including California and Illinois, also have single-payer bills in the hopper.

Like Schiff, President Barack Obama and many Democrats are currently hosting town hall meetings around the country to either pitch the bill and redirect the misconceptions of a national health plan, or to get an idea for how their constituents feel about it.

Republicans are fighting back, with many saying a national system will be expensive, confusing and that it will stifle medical innovation.

In one case in Arcadia’s Methodist Hospital, Anthem refused to transfer a patient-member and verbally approved six days of care at Methodist that came to $55,000 of which the plan paid only $3,000.

The hospital is asking for restitution and unspecified damages.  The Health Care Reform bill purports to change this and other practices that have led to insurance company giants and pharmaceutical companies dictating the direction in which the US goes on health care.

Another health care reform town hall meeting is slated for next week at City of Hope with U.S. House Rep. Judy Chu D-El Monte from 2 p.m. to 3:30 p.m. Aug. 29 at City Of Hope’s Cooper Auditorium.

More from Arcadia Weekly