Minnesota Hospital Association challenges Blue Cross policy shifting services to ASCs

The Minnesota Hospital Association is accusing Blue Cross Blue Shield of Minnesota of breaking the law through policies that limit access to colonoscopies and other services in hospitals in favor of having them in lower-cost settings, like ASCs, according to a letter from the association cited by the Minneapolis StarTribune.

Three details:

1. Through its policies, Blue Cross Blue Shield of Minnesota won't cover such services as endoscopies and colonoscopes in-network at a hospital if an ASC or outpatient clinic within 25 miles offers the same services but at a lower cost. The insurer argued that the policies are identical to those imposed by Medicare for its beneficiaries, and that it is its job to steer patients to lower-cost settings in light of rising healthcare costs. Blue Cross Blue Shield also said that hospitals can meet outpatient clinic pricing to allow patients to have the procedure in the hospital.

2. The hospital association said that the restrictions, which also require patients to get prior authorization for more than 250 services, will limit patients' access to medically necessary treatments and diagnostic services and make the process of getting care more expensive. The association said Minnesota law doesn't allow Blue Cross Blue Shield to discriminate against in-network hospital providers, and that the new policies may break unfair and deceptive trade practice laws.

3. Minnesota Attorney General Keith Ellison said his office will "dig into" the association's concerns.

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