The Nation Law Firm has recently filed a class action lawsuit against Blue Cross Blue Shield of Florida, Inc.
Initially, the Nation Law Firm had sued the Florida Insurance Company for failing to reimburse our client for medical expenses she incurred from two separate back surgeries. The client sought highly specialized, minimally invasive laser disc ablation as opposed to traditional, open back surgery (discectomy). Since none of the providers on the Florida insurance company’s PPO (Preferred Provider Organization) Plan performed such highly specialized surgery, the insured client was required to go out of the PPO network.
Our client paid for the two surgeries out-of-pocket, then turned to Blue Cross Blue Shield of Florida for reimbursement. The Florida insurance company: partially reimbursed her for some of the medical procedures, services, and supplies; approved but did not reimburse her for others; and neither approved nor reimbursed for others. Incredibly, while the insurer approved and partially reimbursed her for laser surgery at one level of her spine, it refused payment for the identical surgery at a different level of her spine (two months later). The reason given for the refusal was “this procedure was submitted with a similar procedure and is not payable on the same service date.”
After filing suit against the Florida insurance company, the Nation Law Firm was contacted by another Blue Cross Blue Shield of Florida PPO policyholder with the identical complaint and identical problems with reimbursement.
Research into the Blue Cross Blue Shield of Florida PPO policy and claims payments by the insurer revealed the Nation Law Firm’s belief that the Florida insurance company’s PPO policy violated Section 627.6044, Florida Statutes, by failing to disclosed actual the specific methodology it used to pay claims. The Nation Law Firm also believes: the PPO insurance policy violates section 627.6471, Fla. Stat., by reimbursing non-PPO providers at a rate lower that allowed by law and also by requiring the insureds to pay coinsurance in excess of the statutory maximum; the PPO Policy states Blue Cross Blue Shield will base reimbursement of non-PPO physicians on “many factors” when in actuality the insurance company bases its reimbursement on a single factor; and the Florida insurance company simply failed to pay the amounts it was obligated to pay (and even approved for payment).
If the class gets certified, the Nation Law firm will represent Blue Cross Blue Shield of Florida PPO policy holders statewide who have obtained services from non-PPO providers.