Gwinnett County teacher Laura Thomas Lowe's heart problems forced her to seek emergency room treatment four times last year, but she'd paid premiums for top Blue Cross and Blue Shield of Georgia coverage, so she didn't worry about the bills.
The hospital was “in network,” with a contract to deliver services for a pre-determined payment from the insurer, Georgia’s largest. But the emergency room doctors were “out of network,” and she wound up with a $3,000 bill.
“I have always been told you have to go to the nearest emergency room if something like this happens,” she said. “I had no idea I had to check out the doctors.”
The "in network" vs "out of network" payments are the heart of a legal battle former Georgia Commissioner John Oxendine and providers are waging against Blue Cross. In a lawsuit filed this week, Oxendine and the providers argue the company has committed fraud by lowering payments to out of network surgical centers while maintaining high premiums as if they were still making the same pay-outs to doctors and clinics. Blue Cross says the charges are unfounded and that providers are fairly compensated.
But Oxendine had a long history of taking on Blue Cross as commissioner before running unsuccessfully for governor in 2010.
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