Health Insurers Target Out-of-Network Surgery Centers, Alleging Inflated Bills

Some insurers have begun to challenge out-of-network bills from outpatient surgery centers, while physicians and surgery centers say the criticism is unjustified, according to a Los Angeles Times report.

Last year, insurance giant Aetna sued several ASCs in Northern California for allegedly overbilling the insurer more than $20 million. The payor has pursued similar actions against providers in New Jersey and Texas, and UnitedHealthcare has filed similar suits in California.

Physicians and surgery centers defend their actions by saying that outpatient surgery facilities reduce healthcare cost by offering easily accessible care at a fraction of hospital prices. According to recent data from the American Hospital Association, ASCs now handle up to 40 percent of all outpatient surgeries.

Blue Shield of California said it hopes to put into place new measures that will better address out-of-network billing issues for employer health plans. The payor said employers should also encourage workers to use in-network facilities that are paid rates agreed upon in a contract with the insurer.  

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