1:30 PM: San Francisco City Attorney Dennis Herrera has sued three medical insurers that he said have systematically underpaid San Francisco General Hospital and other public hospitals for emergency services given to those companies’ policyholders.
The civil lawsuit was filed Tuesday in San Francisco Superior Court against Blue Cross of California, Anthem Blue Cross Life and Health Insurance Company, and Health Net, according to the city attorney’s office.
The suit alleges that the companies have “engaged in a demonstrable and unjust pattern of payment delays and underpayment of claims submitted by SFGH and other public hospitals.”
It seeks an injunction to halt what Herrera’s office said are the companies’ unfair business practices, along with restitution for the alleged underpayments and civil penalties of up to $2,500 for each violation found of the state’s business code.
“The insurers we’ve sued are shortchanging public hospitals and sticking taxpayers with the bill,” Herrera said in a statement.
According to the lawsuit, the companies are refusing to make payments based on the full amount of charges for services, and are instead applying arbitrary reductions to the bills they receive.
“This business practice is not only unfair and illegal, it jeopardizes the city’s ability to provide critically necessary emergency health care,” Herrera said.
San Francisco General Hospital provides the only Level I trauma center for 1.5 million residents of San Francisco and northern San Mateo County, and its emergency department receives more than 50,000 emergency visits per year, according to the city attorney’s office.
City attorney’s office spokesman Jack Song said the three companies would be served with the lawsuit at some point today.
Anthem Blue Cross spokesman Peggy Hinz said in a statement this afternoon that the company had not been served with the suit yet but denies all of the allegations.
“Based on what we understand the allegations to be, we dispute the city attorney’s claim that Anthem has ‘illegally’ been paying less than the full billed charges of the hospital,” Hinz said.
“Where California law requires that an insurer pay a reasonable value for the emergency services rendered, we believe we have followed this requirement. Once we have an opportunity to review the suit, we intend to vigorously defend our practices,” she said.
Health Net spokeswoman Amy Sheyer said her company had received the suit and is evaluating it, but as a policy does not comment on pending litigation.
11:35 AM: San Francisco City Attorney Dennis Herrera has sued three medical insurers that he said have systematically underpaid San Francisco General Hospital and other public hospitals for emergency services given to those companies’ policyholders.
The civil lawsuit was filed Tuesday in San Francisco Superior Court against Blue Cross of California, Anthem Blue Cross Life and Health Insurance Company, and Health Net, according to the city attorney’s office.
The suit alleges that the companies have “engaged in a demonstrable and unjust pattern of payment delays and underpayment of claims submitted by SFGH and other public hospitals.”
It seeks an injunction to halt what Herrera’s office said are the companies’ unfair business practices, along with restitution for the alleged underpayments and civil penalties of up to $2,500 for each violation found of the state’s business code.
“The insurers we’ve sued are shortchanging public hospitals and sticking taxpayers with the bill,” Herrera said in a statement.
According to the lawsuit, the companies are refusing to make payments based on the full amount of charges for services, and are instead applying arbitrary reductions to the bills they receive.
“This business practice is not only unfair and illegal, it jeopardizes the city’s ability to provide critically necessary emergency health care,” Herrera said.
San Francisco General Hospital provides the only Level I trauma center for 1.5 million residents of San Francisco and northern San Mateo County, and its emergency department receives more than 50,000 emergency visits per year, according to the city attorney’s office.
City attorney’s office spokesman Jack Song said the three companies would be served with the lawsuit later today.
Representatives of the companies were not immediately available for comment this morning.
Dan McMenamin, Bay City News
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