Insurance Companies are Being Sued by a Surgery Center that Had Enough

HUNTINGTON BEACH, Calif., Jan. 16, 2023 /PRNewswire/ -- Coast Surgery Center is an outpatient surgery center in the city of Huntington Beach, CA and has been in business since 2018. Coast is a facility for outpatient procedures offering healthcare related services. Just like most medical facilities, before services are rendered to a patient, the provider and facility obtain authorization with the insurance carrier for approval and are provided with the usual, customary, and reasonable (UCR) rate for the procedure. Based on the UCR rate provided by the insurance, the provider and patient understand that if they are to proceed, how much the insurance company will reimburse. All the information obtained is documented by both the insurance carrier and facility as a part of their policy and practice.

Coast provides services to its patients relying on the insurance representations solely based on their statements, promises, and representations. By authorizing a procedure, insurance companies are granting Coast to provide healthcare services to their members, and Coast is fulfilling the insurances' contractual obligations to its members.

The insurance companies significantly started reducing the reimbursement rate from UCR to below Medicare rate in 2018, and for some claims, they didn't pay at all. Since 2019, Coast Surgery Center accumulated bills totaling over $6M. So now Coast is suing some of the largest health insurance providers in the country; United Health Care, Cigna, Aetna, Anthem Blue Cross of California, Blue Shield of California, Blue Cross Blue Shield Associates, and all Blue Cross Blue Shield affiliated companies for illegal, coercive, unfair, fraudulent practices, bad faith and deceptive advertisements.

In the civil case #30-2022-01271476-CU-CO-CJC filed by Coast Surgery Center in Orange County, California, Coast states they billed Blue Cross $49,550 for a surgery and Blue Cross paid $202.99. This is an example for many of the underpaid bills. Insurance companies have had a history of lawsuits for underpaying. As of June 30, 2019, 43% of Anthem's medical bills were unpaid. By 2021, that figure rose to 53%, resulting in a total of $2.5 billion unpaid bills. Yet, Anthem's profits in 2020 were reported to be $4.6 billion and $3.5 billion in the first half of 2021.

These unpaid bills harm medical providers like Coast by failing to provide reasonable rates for its services, negatively impacting the quality of service, value of Coast, and significantly impacting Coast's business relationship with patients and prospects. With this lawsuit, Coast is hoping that the big insurance companies will stop taking advantage of small providers as Coast will continue to provide critical, quality healthcare services and treatment to its Defendants' members on its behalf and hope to be paid reasonable rates.

SOURCE Coast Surgery Center

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