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Hospital Group Asks Minnesota to Investigate Blue Cross Blue Shield

In a July 15 letter, MHA President and CEO Lawrence Massa says the nonprofit insurer’s policies are restricting or delaying patient’s access to medically necessary procedures.

Hospital Group Asks Minnesota to Investigate Blue Cross Blue Shield
(Photo from MHA's Facebook page)

The Minnesota Hospital Association (MHA) is crying foul over recent policy changes implemented by Blue Cross Blue Shield of Minnesota.

In a July 15 letter, MHA President and CEO Lawrence Massa said the nonprofit health insurer’s practices are restricting patients’ access to medically necessary procedures. In some cases, the insurer’s policies are delaying care, Massa wrote.

Under certain conditions, BCBS has stopped reimbursing hospitals for some procedures, including colonoscopies. For instance, if there’s an “ambulatory surgery center” within 25 miles of the hospital, the insurer won’t reimburse hospitals for colonoscopies, even if patients are insured by BCBS.

That new policy went into effect March 4, Massa noted.

“It is important to highlight that BCBS has not terminated its contracts with hospitals or informed them or BCBS subscribers that the hospitals will no longer be considered in-network,” he wrote. “Instead, BCBS simply and unilaterally decreed that it will no longer pay for these covered services when delivered at in-network facilities by in-network providers.”

These and other policies have reduced revenues for some hospitals and clinics, according to MHA.

Massa addressed his letter to Minnesota attorney general Keith Ellison and Minnesota Department of Commerce commissioners Steve Kelley and Jan Malcolm. The MHA represents the interests of 141 hospitals and health systems.

"Without an investigation by your agencies, Minnesota’s hospitals do not have the information necessary to determine how many people have had care delayed, did not receive the appropriate care at all or had negative outcomes because they were unable to receive needed care from the hospital," Massa wrote.

Association officials say the insurer also has “dramatically increased” the number of services it will refuse to cover without a prior authorization.

To obtain prior authorization, doctors need to contact BCBS and ensure that their services or procedures are in fact covered.

“By its own admission, BCBS states that an extraordinarily high percentage of requests for prior authorizations are approved,” Massa wrote in the letter. “In other words, in the vast majority of situations, physicians and patients are making appropriate, evidence-based decisions.”

Furthermore, the prior authorization requirement requires physicians and other clinicians to spend “countless hours navigating online forms and waiting on hold” for BCBS’s subcontractors to answer calls, according to the association.

Massa says his association has made “several attempts” to resolve the issues with BCBS directly.

When reached for comment Monday afternoon, BCBS said it’s instituted the changes as part of a broader effort to keep health care costs down.

“When certain procedures cost less at a specialty outpatient clinic than it does in a hospital setting – and the quality of care is as good or better – it is our job to make sure our members are being guided to that clinic,” BCBS officials said in a statement.

The insurer notes that imaging services performed in outpatient hospital settings can be as much as 45 percent more costly than the same services provided in a specialty clinic.

As for complaints about the prior authorization policy? BCBS says it’s simply enforcing a contractual requirement first established four years ago.

The insurer also says that more than 90 percent of every dollar collected in premiums goes to pay for members’ care.

“Blue Cross has been in discussion with nearly every health system in the state about putting the value of health care first, and how we can collaboratively find a solution to an unsustainable problem,” BCBS said. “At the same time, we accept that some providers are reluctant to change. However, that will not deter us from doing everything we can to take on the underlying costs of care for our members.”

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