Physician Groups Get New Chance at Suit Over Emergency Care Fees

Blue Cross and Blue Shield of Georgia Inc. is facing claims over its denial of payment for thousands of emergency room visits, after the Eleventh Circuit ruled Thursday that it inappropriately applied the “prudent layperson” standard when determining if the services involved an “emergency medical condition.”

The American College of Emergency Physicians and the Medical Association of Georgia won reinstatement of claims filed against the insurer under the Affordable Care Act and the Employee Retirement Income Security Act to recover money for services for which BCBSG, Blue Cross Blue Shield Healthcare Plan of Georgia Inc., and Anthem Insurance Cos. denied ...