Three TeamHealth-affiliated physician groups have filed a lawsuit against Blue Cross and Blue Shield of Texas, alleging that the insurer breached its contract by improperly reducing reimbursements for emergency services.
In the Jan. 24 lawsuit filed in a Texas federal court, the plaintiffs claim that BCBSTX implemented a new coding policy without proper notice, leading to significant financial losses.
The plaintiffs, who staff emergency departments at several Texas hospitals, say that BCBSTX introduced an "Emergency Department Evaluation and Management Services Coding Policy," which took effect in October 2023. The policy allegedly allowed BCBSTX to review and potentially downgrade the level of service billed by the providers, resulting in lower reimbursements.
The providers allege that BCBSTX failed to provide the required 30 days written notice of this change, as stipulated in their contract, rendering the policy invalid and unenforceable. The providers are also arguing that the policy violates ERISA. They claim that BCBSTX’s actions were aimed at increasing its profits and are seeking $4 million in damages, along with a jury trial.