BCBS of Minnesota defends restrictive policies that hospitals call unlawful

Blue Cross Blue Shield of Minnesota held strong against criticism over its new policies that end reimbursement for routine colonoscopies and other services under certain circumstances, according to the Star Tribune.

BCBS of Minnesota issued a bulletin to hospitals on Dec. 3, 2018, indicating the insurer would stop reimbursing hospitals for seven forms of upper and lower gastrointestinal endoscopy for commercially insured members if a cheaper ambulatory surgery center is within 25 miles. The policies, which took effect March 4, include colonoscopies for preventive colon cancer screenings.

Hospitals contend the policies violate state law. The Minnesota Hospital Association, which represents 141 hospitals, sent a letter to state officials arguing the policies break laws against fraud and deception. 

In response, BCBS said it stands by its policies, and on July 19 it rejected claims that it put the policies in place to delay or deny care. It said it is working with South Carolina-based for-profit contractor eviCore to enforce evidence-based policies for paying for and approving care, according to the Star Tribune.

Minnesota Attorney General Keith Ellison, one of the recipients of the hospital association's letter, said his office will investigate the accusations.

Read more here.

More articles on payers:
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Minnesota hospitals ask state to investigate BCBS over new policy ending coverage for 7 forms of routine care
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