The Ambulatory Surgery Center Association, alongside a coalition of 33 healthcare organizations, published a Dec. 8 letter in opposition to a policy by Elevance Health that would require healthcare facilities to absorb costs associated with utilizing providers not in-network with its Anthem Blue Cross Blue Shield commercial plans in 11 states.
The policy, effective Jan. 1, would require facilities participating with Anthem in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Wisconsin to ensure that all providers delivering services to Anthem beneficiaries are in-network. Penalties for failing to adhere to the policy range from a 10% cut to all claims involving an out-of-network provider to termination from Anthem’s network, according to a Dec. 9 news release shared with Becker’s.
“Surgery centers frequently rely on contracted anesthesia, pathology and radiology groups, all of which could be in-network at the time of agreement but can fall out-of-network without notice, something ASCs have no control over,” said Bill Prentice, CEO of ASCA. “Without timely and accurate information from Anthem about changes in status of contracted providers involved in care between the time a surgery is scheduled and when it is performed, the burden of verification wrongly falls on ASCs, with significant penalties lurking behind any missteps.”
Numerous other physician groups, including the American Society of Anesthesiologists, the American College of Emergency Physicians and the American College of Radiology have also urged Elevance to drop the policy.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
