Tenet Healthcare Corp. (NYSE: THC) providers – including its ambulatory surgery center (ASC) arm – are suing Blue Cross and Blue Shield of Florida and affiliate Health Options Inc.
The suit alleges the insurers underpaid or denied more than $21 million in claims for care provided to insured patients across Florida. That care included both inpatient and outpatient health care services, according to Tenet.
Filed July 3 in the 11th Judicial Circuit Court of Florida, the more than 400-page complaint alleges that Blue Cross of Florida failed to properly reimburse for over 1,900 hospital claims and 400 ASC claims between January 2022 and June 2024. At least 37 of Tenet’s surgery centers were included in a list of facilities impacted by the lack of reimbursement.
Broadly, according to the complaint, Tenet contends it fully performed its obligations under existing contracts and that the insurer failed to meet its payment obligations under multiple agreements.
The Blue Cross underpayments or non-payments for Tenet Providers’ ambulatory surgical center claims total over $850,000, the lawsuit states. The hospital-based claims allegedly amount to more than $19 million in additional unpaid services.
“Tenet Providers have attempted to resolve the payment discrepancies with Blue Cross and have exhausted their efforts to do so,” the complaint reads. “Nevertheless, Blue Cross has refused to properly reimburse Tenet Providers for the services rendered, violating the Agreements’ payment provisions.”
The complaint further alleges that the denials were based on inconsistent and vague rationales, such as disputes over coding, prior authorization and medical necessity – often without detailed explanation. Tenet also asserts that it made multiple attempts to resolve the disputes before initiating litigation.
The plaintiffs are seeking damages for breach of contract and breach of the implied covenant of good faith and fair dealing, among other claims.
BCBS of Florida did not immediately respond to a request for comment.
Tenet is scheduled to release its second quarter 2025 financial results on July 22, with a conference call the same day. The Dallas-based health care company is the owner of United Surgical Partners International (USPI), one of the largest ambulatory care platforms in the nation.
