Bay Area Surgical Management Likens Out-of-Network Business to 'Robin Hood' of Healthcare Industry
Julia Hashemieh, co-founder of Bay Area Surgical Management, a California surgery center chain that was recently sued by Aetna for alleged overbilling, likened the chain's out-of-network strategy to acting as the "Robin Hood" of the healthcare industry, in a Bloomberg Businessweek report.
She explained that the surgery center chain takes from rich insurance companies, keeps 15 to 25 percent of the profit, and gives the remainder to surgeons, whom Ms. Hashemieh called "the poor slaves" of managed care. The seven Silicon Valley surgery centers collect approximately $100 million in annual revenues.
The company pays profits to around 60 physician partners, and rates of return frequently exceed 200 percent annually. Patients are charged little because the chain waives and reduces co-pays, and the centers' reputation for high-quality care keeps volume high, according to the report.
While insurance companies do not pay all of the centers' bills in full, they pay enough to let the facilities collect four to seven times of the rates earned by in-network providers. Aetna sued Ms. Hashemieh and her partners in February, claiming they pay surgeons excessive compensation for referrals and gouge on rates. The insurer alleged that the Bay Area Surgical Management centers lured patients by waiving co-pay responsibility for out-of-network care and placing the financial burden on the insurer.
The owners said the surgery center chain has no obligation to collect co-pays, because it has not contracted with Aetna. Ms. Hashemieh told Bloomberg Businessweek that America's physicians are protected from corporate consolidation when they can earn a reasonable living through surgery center ownership.
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