Blue Cross deal derailed by $5.2 million in unpaid bills

Posted Tuesday, Nov. 25, 2008 Comments   (0) Print Share Share Reprints
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By ANTHONY SPANGLER

aspangler@star-telegram.com

FORT WORTH -- A request by Blue Cross Blue Shield of Texas for $4.7 million in tax breaks to build a data center in the Alliance business corridor was derailed Tuesday when Tarrant County officials discovered the health insurance provider owes the county hospital $5.2 million in unpaid charges.

Tarrant County Administrator G.K. Maenius said the issue of unpaid bills to the taxpayer-supported Tarrant County Hospital District, which does business as the JPS Health Network, will be reviewed before Tarrant County Commissioners are again asked to vote on the tax abatement.

The insurance company's contract with JPS was canceled in mid-July when reimbursement rates could not be agreed upon. Both sides claim the other party is responsible for letting the contract lapse. JPS was seeking to get a higher reimbursement from Blue Cross Blue Shield because the rates had not been negotiated since 2002.

Because the parties do not have contracted rates of reimbursement, JPS is billing the insurance company for full charges -- a price far above normal negotiated rates. Typically patients who pay cash for services are the only ones who pay full charges.

But Blue Cross Blue Shield is refusing to pay full charges, said Dee Chaisson, JPS vice president of finance. "When we bill them for someone covered under Blue Cross, they want to pay within a dollar of the previous contract rates, claiming they are 'reasonable and customary,'" she said. "But we don't have a contract, so we are billing them full charges. They keep telling us no and say we have to submit an appeal."

Every time JPS has appealed a charge to Blue Cross Blue Shield, Chaisson said, JPS has subsequently filed a complaint with the Texas Department of Insurance. She said JPS has filed 75 to 100 complaints since mid-July when the Blue Cross Blue Shield contract was dissolved.

Chaisson said $2.5 million of the unpaid bills to Blue Cross Blue Shield were for claims submitted prior to mid-July when the contract ended.

ANTHONY SPANGLER, 817-390-7420

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