Health Insurers Target Out-of-Network Surgery Centers, Alleging Inflated Bills
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.
Related Articles on Coding, Billing and Collections:
Northeast Georgia Health Hires VP of Revenue Cycle
StenTel, M-Scribe Partner for Revenue Cycle Management Services
4 Tips for Healthcare CEOs to Maintain Billing Compliance
© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
- Senate Democrats urge Zika funding finalization: 4 things to know
- Cigna & Hill Physicians Medical Group team up to deliver coordinated care— 5 points
- Seaside Surgery Center checks off its 1st outpatient spinal surgery: 5 highlights
- Rush University Medical Center to open $36.2M outpatient health center — 5 highlights
- 5 GI physicians in the news — July 1, 2016