Law Street Media

Blue Cross Blue Shield Reimbursement Suit Removed from LA County

Blue Cross Blue Shield's logo on a building.

"Lansing, Michigan, USA - March 14, 2012: The Blue Cross Blue Shield location in Lansing, Michigan. Founded in 1929, the Blue Cross Blue Shield Association is a network of insurance organizations that insure almost 100 million Americans."

Blue Cross Blue Shield of Illinois (BCBS) removed a lawsuit over insurance coverage filed against it in Los Angeles state court to the Central District of California federal court on Tuesday. The plaintiff in the suit, Ramin M. Roohipour, M.D., filed the case against BCBS Illinois earlier this year and filed a first amended complaint on June 7.

Roohipour alleged in the amended complaint that certain claims they had submitted to BCBS Illinois for the purpose of reimbursement were never completely fulfilled. Rather, they were only partially fulfilled. 

The claims were filed for three separate patients, totaling a sum of $610,000. The complaint described the sum as being “customary and reasonable.” The plaintiff was improperly compensated by BCBS Illinois when the defendant paid only a small portion of what the claims requested – $4,123.33. This left a significant amount of the claim outstanding. Due to the misconduct, the plaintiff filed suit initially to seek damages of $605,876.67 for the services rendered to the three patients.

The defendant’s notice of removal of civil action explained that since they have “complied with all statutory requirements, removal is appropriate.” Additionally, their response to the first amended complaint has changed from being due on August 17, 2021, to now being due on September 16, 2021, a conclusion which the respective parties claim to have reached together.The plaintiff is represented in the litigation by themselves, while the BCBS Illinois is represented by Reed Smith LLP.

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