Dental group sues Blue Cross

posted on:
January 7, 2005

author:
Staff

 The Alabama Dental Association is suing Blue Cross and Blue Shield of Alabama, claiming the insurance company defrauded roughly 1,600 dentists out of more than $100 million in reimbursements. 

The class-action lawsuit, filed in U.S. District Court last week, alleges Blue Cross pays dentists in an untimely manner, and often only a fraction of the agreed-upon reimbursement.

“They have a practice set up by design to systematically deny, delay and diminish payments to dentists,” said Jere Beasley, a lawyer representing the association.

Blue Cross emphatically denies the allegations.

“We obviously don’t feel there’s any merit to this lawsuit,” said Grey Till Jr., general counsel for Blue Cross.

Till declined to comment further, citing pending litigation. He directed all questions to the company spokesman, Jim Brown, who didn’t return three calls to his office Thursday.

The director of the Alabama Dental Association said Blue Cross has been breaking contracts with association members for more than a decade.

“Blue Cross tends to operate as they see fit until they are successfully challenged,” said Wayne McMahan.

McMahan said the association tried repeatedly to reach an agreement with Blue Cross before deciding to file the lawsuit. The lawsuit alleges three types of wrongdoing by Blue Cross:

  • The company uses an automated system to substitute dental codes into a computer so dentists receive less for their services than they should. For example, Blue Cross reimburses dentists for composite (clear) fillings at the cost of amalgam (silver) fillings, which are 10 percent to 15 percent cheaper, McMahan said.
  • The company sometimes refuses to pay for two of the same dental procedures if both procedures are presented on the same bill. For example, dentists who work on two cavities on the same tooth are only paid for working on one of the cavities, McMahan said.
  • The company often doesn’t reimburse dentists within 30 days, as is required by law, McMahan said. McMahan said it can take months for dentists to receive insurance payments.
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