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KAILUA-KONA — Kaiser Permanente on Wednesday filed a lawsuit against The Queen’s Health Systems after Queen’s told the health plan it will be billing Kaiser members for the balance of any emergency services it provides that aren’t reimbursed.

The lawsuit comes after a hospital services agreement between The Queen’s Medical Center and Kaiser expired on May 30, making The Queen’s Health Systems hospitals, including North Hawaii Community Hospital in Waimea, no longer participating providers within Kaiser’s network.

A Kaiser spokesperson said earlier this week that Kais...

Emergency Department physicians being out of network is nothing new, but a new round of failed negotiations between a local emergency physician group and Blue Cross Blue Shield of Texas have both sides crying foul and pointing fingers.

Blue Cross Blue Shield contacted members to describe how Texas Medicine Resources, a physician group hired by Texas Health Resources emergency rooms, has terminated its deal with BCBSTX, meaning the group is now out of network at 14 area hospitals for its Blue Choice PPO and Blue Essentials HMO members.

A statement on BCBSTX’s “St...

Fairfield, Calif.-based NorthBay Healthcare may recover $16 million-plus from Blue Shield of California after a federal jury in San Francisco found the health insurer underpaid the hospital system for emergency care.

On Feb. 13, after a six-day trial, the jury found Blue Shield owed NorthBay 67 percent of its billed charges, according to law firm King & Spalding, which represented NorthBay. The exact amount of damages has yet to be determined, but is currently estimated at more than $16 million.

The case stems from December 2016, when Blue Shield and NorthBay ended...

There is a growing outcry on Capitol Hill over surprise emergency room bills — and now emergency room doctors themselves are rolling out a plan to do something about it.

Here’s the basic problem: As Vox and others have reported, in-network emergency rooms are often staffed by out-of-network doctors. This can lead to hefty bills for patients who think their providers are covered.

One patient I wrote about, for example, ended up with a $7,924 bill for emergency jaw surgery even though he was seen at an in-network hospital. The surgeon who saw him, it turns out, wasn’t...

Blue Shield of California is unfairly targeting hundreds of thousands of Covered California enrollees with a coverage change that would prevent them from getting routine care when they are working outside of California, one enrollee told The Sacramento Bee.

Philip Martin has been trying to get Blue Shield to reverse its decision to limit out-of-state medical coverage for PPO members whose policies didn’t go into effect before Jan. 1, 2014, the date when coverage under the Affordable Care Act went into effect. Blue Shield is limiting out-of-state coverage to urgent c...

On Aug., 1, 2017, Brittany Cloyd of Frankfort, Kentucky, said she experienced pain "worse than childbirth." Her mother -- who had been to nursing school -- drove her to the nearest emergency room. Brittany thought her appendix had burst, but tests at the ER found she had ovarian cysts. She was given pain medication and told to follow up with her primary doctor.

Cloyd had an Anthem Blue Cross PPO health insurance plan and thought she would get charged just a co-pay for her ER visit. Instead, 15 days later she received a letter from health insurer Anthem. "Your condit...

Drew Calver took out his trash cans and then waved goodbye to his wife, Erin, as she left for the grocery store the morning that upended his picture-perfect life.

Minutes later, the popular high school history teacher and swim coach in Austin, Texas, collapsed in his bedroom from a heart attack. He pounded his fist on the bed frame, violent chest pains pinning him to the floor.

"I thought I was dying," the 44-year-old father recalled. He called out to the only other person in the house, his oldest daughter, Eleanor, now 7. Using the voice-recognition feature on his p...

The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) today filed suit against Anthem's Blue Cross Blue Shield of Georgia in federal court in an effort to compel the insurance giant to rescind its controversial and dangerous emergency care policy that retroactively denies coverage for emergency patients. To read the lawsuit, click here.

Over the past year, Anthem implemented its policy in Georgia and five other states, leaving patients who sought emergency care responsible for paying their entire bills if the insurance comp...

A controversial policy instituted by Blue Cross Blue Shield of Georgia and parent company Anthem Insurance Cos. denying emergency room claims after the fact faces a legal challenge by two physicians organizations.

The American College of Emergency Physicians and the Medical Association of Georgia have asked a federal judge in Atlanta to compel Blue Cross Blue Shield and Anthem to abandon the policy, which the insurers have also implemented in Missouri, Kentucky, Indiana, New Hampshire and Ohio.

The policy, which the insurers announced last year, allows the companies...

In 2017, insurance company Anthem, Inc. began implementing new medical coverage policies that affect emergency services and medical imaging. As to the former, Anthem’s new policy allows it to reduce coverage for emergency services provided if Anthem later determines that the situation giving rise to the services was not, after all, an emergency. As to the latter, Anthem is denying certain claims for medical imaging performed at hospitals rather than at clinics. In March of this year, Senators Claire McCaskill (D-Mo.) and Ben Cardin (D-Md.) sent a letter to the Depa...

One of the main principles behind purchasing health insurance is protection in the event of an emergency.

But in the case of Anthem, the nation's second-largest insurer, policy holders may be denied coverage if the company considers their visit to the emergency room unnecessary.

Under the health insurance company's "avoidable ER program," Anthem can retroactively restrict or deny coverage if the company decides that the patient didn't actually have an emergency condition. For instance, if you went to the ER for chest pain that turned out to be attributed to anxiety o...

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