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TSJH Sues BlueCross BlueShield

Posted/updated on: November 13, 2014 at 1:34 pm
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thumb_Texas-Spine-and-Joint-HospitalTYLER — Texas Spine & Joint Hospital (TSJH) filed a lawsuit in Smith County Wednesday against BlueCross BlueShield of Texas (BCBS), a division of Health Care Service Corporation. KETK reports that TSJH seeks damages for years of disputed payments for patient care provided to BCBS members. Further, the hospital argues that BCBS is in violation of the Texas Free Enterprise and Antitrust Act by having only one contracted or “in-network” hospital facility in the Tyler, Texas, area. TSJH officials say BCBS has taken the position that only one hospital in Smith County should be in network with BCBS. BCBS had no immediate comment on the lawsuit when contacted by KTBB.

“Our goal is to be able to allow BCBS members to access our expert care without worry as to what their insurance may pay,” states Tony Wahl, Texas Spine & Joint Hospital CEO. “We believe there is a strong patient demand to have more than one hospital in network with BCBS, as most if not all other payors in this market contract with more than one hospital.”

Texas Spine & Joint Hospital ranks among the Top 100 hospitals nationally for Patient Satisfaction and is in the Top 10% nationally for Medical Excellence in multiple categories according to CareChex, a division of Comparion. Since opening in 2002, TSJH has continually worked towards contracted status with BCBS and sought reasonable reimbursement for care provided to BCBS members, according to information from the hospital. According to hospital administration, all attempts to resolve the issue administratively have been exhausted or proven futile. During the lawsuit, Texas Spine & Joint Hospital will continue to accept BCBS members and access will not be affected.

Texas Spine & Joint Hospital administration makes note that the lawsuit is strictly between the hospital and BCBS. The actions of the suit are not intended to be detrimental to area healthcare providers who are currently contracted with BCBS, according to hospital officials.



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