Tyler hospital files lawsuit against Blue Cross Blue Shield

Published: Nov. 12, 2014 at 4:36 PM CST|Updated: Nov. 3, 2017 at 11:48 PM CDT
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TYLER, TX (KLTV) - Texas Spine & Joint Hospital filed a lawsuit Wednesday in Smith County against Blue Cross and Blue Shield of Texas.

The hospital says it is seeking damages for what it's calling years of disputed payments for patient care provided to BCBS members. The hospital says it is also arguing that BCBS is in violation of the Texas Free Enterprise and Antitrust Act by having only one contracted or "in-network" hospital facility in the Tyler area.

The hospital says BCBS has taken the position that only one hospital in Smith County should be in network with BCBS.

"Our goal is to be able to allow BCBS members to access our expert care without worry as to what their insurance may pay," said Tony Wahl, TSJH CEO. "We believe there is a strong patient demand to have more than one hospital in network with BCBS, as most if not all other payors in this market contract with more than one hospital."

The hospital says that since opening in 2002, TSJH has worked towards contracted status with BCBS and sought reasonable reimbursement for care provided to BCBS members.

According to the hospital, it will continue to accept BCBS members and access will not be affected. Hospital administration also notes that the lawsuit is strictly between the hospital and BCBS. The actions of the suit are not intended to be detrimental to area healthcare providers who are currently contracted with BCBS.

KLTV 7 reached out to BCBS. "As this is a matter of pending litigation, we're unable to discuss," says Louis Adams, BCBSTX spokesperson.

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