HUNTINGTON BEACH, Calif., Jan. 16, 2023 /PRNewswire/ — Coast Surgical procedure Middle is an outpatient surgical procedure heart within the metropolis of Huntington Seashore, CA and has been in enterprise since 2018. Coast is a facility for outpatient procedures providing healthcare associated providers. Identical to most medical amenities, earlier than providers are rendered to a affected person, the supplier and facility receive authorization with the insurance coverage service for approval and are supplied with the same old, customary, and affordable (UCR) price for the process. Primarily based on the UCR price offered by the insurance coverage, the supplier and affected person perceive that if they’re to proceed, how a lot the insurance coverage firm will reimburse. All the data obtained is documented by each the insurance coverage service and facility as part of their coverage and apply.

After being owed over $6M, Coast Surgical procedure Middle has had sufficient and is suing the insurance coverage corporations.

Coast gives providers to its sufferers counting on the insurance coverage representations solely based mostly on their statements, guarantees, and representations. By authorizing a process, insurance coverage corporations are granting Coast to supply healthcare providers to their members, and Coast is fulfilling the insurances’ contractual obligations to its members.

The insurance coverage corporations considerably began decreasing the reimbursement price from UCR to beneath Medicare price in 2018, and for some claims, they did not pay in any respect. Since 2019, Coast Surgical procedure Middle gathered payments totaling over $6M. So now Coast is suing a few of the largest medical insurance suppliers within the nation; United Well being Care, Cigna, Aetna, Anthem Blue Cross of California, Blue Defend of California, Blue Cross Blue Defend Associates, and all Blue Cross Blue Defend affiliated corporations for unlawful, coercive, unfair, fraudulent practices, dangerous religion and misleading commercials.

Within the civil case #30-2022-01271476-CU-CO-CJC filed by Coast Surgical procedure Middle in Orange County, California, Coast states they billed Blue Cross $49,550 for a surgical procedure and Blue Cross paid $202.99. That is an instance for lots of the underpaid payments. Insurance coverage corporations have had a historical past of lawsuits for underpaying. As of June 30, 2019, 43% of Anthem’s medical payments have been unpaid. By 2021, that determine rose to 53%, leading to a complete of $2.5 billion unpaid payments. But, Anthem’s income in 2020 have been reported to be $4.6 billion and $3.5 billion within the first half of 2021.

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These unpaid payments hurt medical suppliers like Coast by failing to supply affordable charges for its providers, negatively impacting the standard of service, worth of Coast, and considerably impacting Coast’s enterprise relationship with sufferers and prospects. With this lawsuit, Coast is hoping that the large insurance coverage corporations will cease making the most of small suppliers as Coast will proceed to supply vital, high quality healthcare providers and remedy to its Defendants’ members on its behalf and hope to be paid affordable charges.

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SOURCE Coast Surgical procedure Middle