A lawsuit that was filed last year by customers of Blue Shield who are suffering from limb loss made several allegations against the company, claiming that it is violating the terms of its contracts with customers in several ways. One of the allegations contained in the lawsuit is that the company wrongfully has a very small network of prosthetists, which results in individuals who need artificial limbs often being forced to pay a large percentage of the cost out of their own pockets.
According to the lawsuit, Blue Shield’s contract with its customers has language about in-network providers. The contract states that:
The Blue Shield health plan is designed for Members to obtain services from Blue Shield Participating Providers and MHSA Participating Providers. However, Members may choose to seek services from Non-Participating Providers for most services. Covered Services obtained from Non-Participating Providers will usually result in a higher share of cost for the Member. Some services are not covered unless rendered by a Participating Provider or MHSA Participating Provider.
The lawsuit alleges that implicit in the language in the Blue Shield policies is the promise that Blue Shield will develop a fully formed network of providers which will allow a member to receive the primary benefit of the contract, which is to give members the right to receive services from an in-network provider. However, according to the lawsuit, Blue Shield has been unable to maintain an adequate network of prosthetists because of its very low reimbursement rates to them. Therefore, according to the lawsuit, members who have suffered from limb loss are often forced to use out-of-network prosthetists, which leaves the members with a large out-of-pocket expense.
If you have insurance with Blue Shield and you have been left with a large bill for an artificial limb, call me, Conal Doyle, Amputation Attorney, at 310-385-0567. I am currently working on several lawsuits against insurance companies on behalf of amputees, including the lawsuit against Blue Shield. Call today to learn more or to schedule a free consultation.