Minnesota hospitals are questioning Blue Cross Blue Shield of Minnesota's competence as the insurer imposes new limits on care, according to the Star Tribune.
In August 2018, BCBS of Minnesota outsourced its prior authorization reviews to 1,100 physicians working for eviCore, a Cigna-owned company based in South Carolina. While BCBS of Minnesota argues the move aims to address unsustainable spending in healthcare, some members are claiming it has left them with delayed or denied care.
Matt Anderson, senior vice president for policy at the Minnesota Hospital Association, told the Star Tribune: "The problem with Blue Cross is not that it has prior authorization. It's that it's incompetent at managing its prior authorization. The manner in which Blue Cross and its subcontractor are administering prior authorization is resulting in delayed and denied care for patients that is medically necessary ... [and] denied payments to not just hospitals, but mental health providers and clinics across the spectrum."
The Minnesota Hospital Association, which represents 141 hospitals, sent a letter to state officials arguing the policies break laws against fraud and deception. However, BCBS of Minnesota has strongly defended its policy. Craig Samitt, MD, CEO of BCBS of Minnesota, said the insurer's new system for prior authorizations will lower unnecessary spending.
"We can't just be a claims and network company as a health plan," Dr. Samitt told the Star Tribune. "I worry that, if costs continue to rise unsustainably, Medicare for All is a very possible outcome. I worry that if we don't reinvent our industry from the inside out, someone will reinvent us from the outside in."
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