Earlier this week, Health Care Service Corporation doing business as Blue Cross and Blue Shield of Texas filed a notice to remove an in-network underpayment lawsuit brought against the company from state court to the Southern District of Texas.
Texas-based physician group Texienne Physicians Medical Associations, PLLC (TPMA) originally filed a suit in November 2021 against health insurance company Blue Cross and Blue Shield (BCBS) in the District Court of Montgomery County, Texas, claiming BCBS has failed to pay for services rendered to it.
The complaint states that “TPMA has fully complied with its obligations to receive payment from BCBS and timely submitted clean claims for reimbursement by BCBS. However, BCBS has failed to pay TPMA for clean claims in excess of $350,000.”
The plaintiff also claims it filed all paperwork necessary to receive such pavements and has waited the necessary time given to insurance companies to comply with such requests. Other assertions made by the plaintiff are based on its contractual obligations to comply with such claims since TPMA was within network of the patients.
The plaintiff contends that under the Employee Retirement Income Security Act of 1974 “a health plan participant or beneficiary may bring a civil action to recover action to recover benefits due under the terms of the plan and to enforce rights under the terms of the plan.” As such, the defendant is facing one count under ERISA.