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Blue Cross Must Pay $12 Million More

ATLANTA -- State Insurance Commissioner John Oxendine has ordered Georgia's largest health insurer to make an estimated $12 million in additional payments for ambulance services that he said were improperly reimbursed.

Under the consent order, Blue Cross and Blue Shield of Georgia will compensate ambulance companies that it underpaid as well as consumers who were billed inappropriate amounts for rides, including after 911 calls.

Those people could be eligible for hundreds of dollars if an ambulance company charged them a higher amount to cover an underpayment from Blue Cross.

Oxendine announced the consent order Thursday.

The ambulance companies improperly paid were not in the Blue Cross network. Oxendine said most of the rides came from 911 emergency calls.

"If you're calling 911, you don't know who's coming," Oxendine said. In an emergency, he said, "you can't be picking who you're going to call."

Blue Cross, which has more than 3 million policyholders, admitted no wrongdoing while agreeing to the consent order.

"We've agreed to this with the commissioner in order to resolve the matter," said Mark Cohen, an attorney with Troutman Sanders who is representing Blue Cross.

Cohen said Blue Cross "tried to do the right thing" when it received complaints about ambulance payments. "There was no malice," he said.

Blue Cross will increase its ambulance payment rates as a result of the order.

The problem payments involve more than 38,000 claims paid by Blue Cross, including 600 air ambulance trips, since January 2006. More than 500 ambulance companies are involved in the rides, state insurance officials said.

"The majority of these cases are in smaller communities, second-tier cities, where the trauma need is much greater," Oxendine said.

Underpayments jeopardize the survival of ambulance firms in these areas, he said. "The availability of trauma care is at a shameful level in this state," Oxendine said. "This is a very important part. We have to make sure we fix it in the future."

Georgia has only 15 hospitals that specialize in trauma care, and many are losing millions of dollars providing the expensive service. Researchers say 700 people die annually because of Georgia's inadequate trauma coverage.

Oxendine said the insurance department would also review other insurance companies' payments for ambulance rides.

Ben Hinson, owner of Macon-based Mid Georgia Ambulance, which serves eight counties, estimated the average Blue Cross underpayment at $400 per ride.

"We had to go after the patient and make them pay the balance," Hinson said. "It caused a lot of confusion and hardship.

"This will help everyone who will need an ambulance in the future," Hinson said.

Blue Cross said Thursday the company would contact both companies and consumers involved in the payment problem.

Consumers seeking information about the repayments can call state insurance officials at 1-800-656-2298.

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