BlueCross BlueShield of Tennessee Files Motion Against TMA Lawsuit.

Business & Health/Medical Writers

CHATTANOOGA, Tenn.--(BUSINESS WIRE)--May 28, 2002

BlueCross BlueShield of Tennessee moved today for a stay or dismissal of lawsuits filed by the Tennessee Medical Association (TMA) and two individual physicians. On April 25, the TMA sued BlueCross BlueShield of Tennessee and three other major insurance carriers operating in Tennessee for unfair and deceptive reimbursement practices, with specific complaints about the use of computer programs to review claims.

"We vigorously deny the allegations against us," said Senior Vice President Ron Harr. "BlueCross BlueShield of Tennessee employs computer technology to detect intentional and unintentional duplicate billings and errors. This is an industry-wide practice designed to compensate physicians accurately and fairly, not to deny them compensation that they deserve," he explained.

"Furthermore, it is our belief that these issues have not yet been addressed through the appropriate channels. The Tennessee Medical Association should not be burdening the court system with payment concerns that can and should be resolved through arbitration."

Of 22,000,000 claims paid each year by BlueCross BlueShield of Tennessee, providers filed formal disputes on only 1,000 claims and have requested arbitration on a total of only 10 claims in the past six years. The two individual physicians named as plaintiffs in the lawsuit have never appealed a single claim through BlueCross BlueShield of Tennessee's formal provider dispute resolution procedure.

"We find this lawsuit especially surprising since the TMA has worked so hard for tort reform and a reduction in frivolous court action," Harr added.

"The real issue in Tennessee is the affordability of health care and health insurance. Commercially-insured Tennesseans are already paying 25 percent more than the national average for physician services," Harr pointed out. "We don't understand why the TMA is not working with us to make health care more affordable for Tennesseans."

Harr concluded, "We want to make sure that physicians are compensated fairly and accurately for their services, but it is our duty to our subscribers to do everything we reasonably can to make sure that the price they pay for health care is no higher than it should be."

BlueCross BlueShield of Tennessee is the state's leader in health care financing. Founded in 1945, the Chattanooga-based not-for-profit company now serves more than 4.1 million people. The company paid more than 42 million claims and $11.7 billion in health care benefits in 2001. BlueCross BlueShield of Tennessee has more than 4,300 employees. For more information on BlueCross BlueShield of Tennessee, visit the company's Web site at www.bcbst.com. BlueCross BlueShield of Tennessee is an independent licensee of the BlueCross BlueShield Association.