July 23, 2004 – Roy L. Schneider Hospital filed suit on Monday in U.S. District Court against Blue Cross and Blue Shield of the Virgin Islands in an attempt to collect $5.1 million the hospital claims the company owes it.
Blue Cross insured V.I. government workers from April 1, 1998, to Sept. 30, 2001.
The amount consists of $4 million for medical services rendered between those dates plus $1.1 million in interest.
"This is not a snap decision, " Amos Carty, the hospital's chief operating officer, said on Thursday.
Rodney E. Miller Sr., Schneider chief executive officer, said the hospital filed the suit as a last resort.
Butch Ward, Blue Cross vice president for corporate and public affairs, said in a prepared statement that the company disputes the hospital's claims. He said the hospital has refused to answer questions and to allow Blue Cross to conduct an audit.
"They never requested an audit," Carty said.
Ward said that Blue Cross will file a counterclaim. He said the company is willing to pay what it owes, but no more. And he said the hospital's claims are unsubstantiated.
Carty said Blue Cross maintains that some claims are duplicates or for people not covered by the Blue Cross policy.
He said there had been no problems with Blue Cross until after its contract ended.
Miller said he had no luck working to resolve the issue, so the hospital was forced to file suit. He said that Blue Cross had repeatedly assured the hospital that final reconciliations and payment were imminent.
According to Miller, the amount Blue Cross owes the hospital was verified by an independent consulting firm specializing in health-care financial issues. "The firm told us that this number is conservative, because they say there are many unidentified patients who had reached their cap for co-payment," he said.
Miller said the hospital asked for information on these patients, but Blue Cross refused to provide it.
Carty said it was important for the hospital to file the suit so other insurers wont follow Blue Cross' example and not pay their bills.
Ward said Blue Cross paid $11.98 million in claims to the hospital during the time it insured government workers.
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