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| Grewal Law, PLLC

Doctors and health care providers, like everyone else, want to be paid fairly for the services they provide.  For patients with health insurance, one would think the insurance company would pay the doctor an adequate amount.  After all, that’s why you pay such a high premium, right?

A Georgia lawsuit is challenging health insurers, specifically Blue Cross Blue Shield of Georgia, to explain why premiums have remained high while payments to doctors have decreased.  Blue Cross Blue Shield of Georgia is the state’s largest health insurer, just as Blue Cross Blue Shield of Michigan is the largest insurer in our state.

According to the suit, filed by Georgia’s former Insurance Commissioner, BCBS of Georgia overcharged consumers because it was reducing payments to out-of-network medical providers without also cutting premiums.  “Out-of-network” providers are typically more expensive because they are not bound to a contractual payment rate with the insurer like “in-network” providers are.

Blue Cross Blue Shield of Georgia denies any wrongdoing and claims it has fairly compensated all doctors.


  1. Gravatar for Yvett Boyd
    Yvett Boyd

    Oh, yes, please do keep updates on the outcome of this dispute. I work with various BCBS, Empire, and Anthem BC plans as well as CIGNA, Aetna, and United Healthcare. As far as I can say, they do NOT pay more for out of network, have huge adjustments to take. Now, I will say, per my experience, only the River Valley JohnDeere (formerly known, but is United Healthcare) since they were Quad City only, and many employees had no choice than to see ER or specialty specific providers at the UI , the plan actually paid at 100% back in 2005-2007. But BCBS and Cigna, Empire NY...hahaha! Don't even get me started. I swear they have my picture in thier office as a fire breathing dragon. The entire office knows when I am on the phone with them. I am very passionate about understanding from a patient's, provider's, and insurance carrier perspective as to why rates go up, coverage goes way down, and "bundling /inclusivity" and Provider Enrollment issues are always the #1 denial or payment set backs.

  2. Gravatar for Jack Spoooner
    Jack Spoooner

    I have filed numerous lawsuits in state and federal court against BCBS, Cigna, UH and Conventry on behalf of providers who have been improperly paid or denied a payment that is without question rightfully due (preauthorized, preapproved and correctly billed), in direct contradiction with policy/plan terms. Would like to discuss in more detail. Please contact me.

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