Louisiana state law requires insurance companies to send such payments directly to healthcare providers, even out-of-network providers, if the patient signs an "assignment of benefits" form, which nearly all standard hospital and ASC check-in forms include. After the hospitals complained to the state Department of Insurance, Blue Cross filed a federal law suit against the two hospitals, the state of Louisiana and the Louisiana attorney general, asking the federal court to declare that the state law should be pre-empted by the federal ERISA law. ERISA covers many different aspects of health benefits, and Blue Cross believed its application would allow the company to sidestep state law.
However, the federal court ruled that Blue Cross must follow state law and send payments directly to healthcare providers. This is a boost for in-network providers that might feel coerced out of going out-of-network and into accepting too-low payments, and out-of-network providers that might otherwise have a tough time recouping payments directly from patients.
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.