Physician group severs contract with Anthem & 5 more payer updates

From a Maine physician group ending its contract with Anthem to Blue Cross Blue Shield updating its colonoscopy policy, here are six payer updates from the last 60 days:

1. Portland, Maine-based independent practice Fore River Urology is ending its contract with Anthem. Beginning Aug. 1, the practice will no longer be an in-network provider for those with commercial Anthem plans. Coverage ends Sept. 1 for those with Anthem Medicare Advantage, the report said. 

2. Advanced Surgery Center in Fort Lee, N.J., has filed a lawsuit against UnitedHealthcare for allegedly failing to pay for hernia-related procedures.

3. Anthem has captured the attention of several U.S. hospitals and health systems as allegations of underpayment and inappropriate denials grow. The insurer has been forced to pay millions and continues to face off with providers.

4. Health Care Service Corp., the parent company of BCBS of Illinois, was fined hundreds of thousands of dollars after terminating its contract with a 600-physician medical group and ASC.

5. Blue Cross Blue Shield has changed its colonoscopy policy after a patient in Greensboro, N.C., complained about lack of coverage.

6. According to a new study, Medicare per-procedure payments to hospital outpatient departments were 2.1 times larger than payments to ASCs. Private insurer payments to hospital outpatient departments were 2.6 times larger than payments to ASCs.

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