On Monday a case was filed in Miami-Dade County, Florida state court by Dr. Alfredo Murciano against Blue Cross Blue Shield of Florida. The case is regarding underpayment of medical bills.
Plaintiff Dr. Murciano is an infectious disease specialist and participated in the treatment of a premature newborn with sepsis, the complaint said. Per the plaintiff, the patient’s condition was severe and required emergent treatment due to the possibility of death. Dr. Murciano was the only infectious disease specialist on site and there was no time to effect a transfer to another facility that would have an in-network physician.
Dr. Murciano, the complaint said, is an out of network physician with BCBS of Florida and does not have a contracted rate of payment, instead expecting a payment per usual and customary pricing for physicians providing his services in that geographical region. Plaintiff argues that since the insured has already met his maximum allowable out of pocket for the coverage year, the emergency services provided by the plaintiff must be met by BCBS at the usual and customary rate instead of being assigned to patient responsibility as per the current processing.
The plaintiff is suing for breach of contract as third party beneficiary to insured contract between the plaintiff and the patient, unjust enrichment, and violation of the Florida’s emergency medical treatment statute. Plaintiff is represented by Tache Bronis and Descalzo.
