Hospitals in Minnesota are calling on the state to look into a new policy enacted by its largest nonprofit health insurer that ends reimbursement for routine colonoscopies and other services under certain circumstances, according to the Star Tribune.
Blue Cross Blue Shield 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 policy, which took effect March 4, includes colonoscopies for preventive colon cancer screenings.
It also requires patients to obtain prior authorization for select services, which the hospitals argue will delay coverage for more than 250 services that ultimately will be approved, according to the Star Tribune.
In a letter to state officials, the Minnesota Hospital Association, which represents 141 hospitals, contends BCBS of Minnesota's new policy violates state law. However, the insurer said not only do its rules echo those recently implemented by Medicare, but are needed to subdue rising healthcare costs.
The payer said in some cases, hospitals have been asked to lower their prices of certain services to receive coverage, and some have obliged. BCBS of Minnesota also argues its rules are legal, 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 the full letter here.
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