Regence pressures ambulatory surgery centers about reimbursement


Regence Blue Cross Blue Shield in Oregon has been pressuring ambulatory surgery centers to sign contracts that allow the insurer to send reimbursement payment directly to patients and then requiring centers to track down those checks.

For example, neurosurgeon Jonathan Sherman, who works at the Spine Surgery Center, told the Oregon Senate Health Committee last week that Regence and other insurers have attempted to coerce him into agreeing to contracts that reimburse him for only 25 percent of his cost. What's more, he said, insurers' payments that are sent to patients amount to only about 40 percent to 60 percent of physician charges, according to a Lund Report article.

Because of this allegedly unfair practice, Oregon Sen. Alan Bates has introduced legislation (S.B. 366) to require that insurers provide reimbursements directly to the doctors who provided care at the ambulatory centers.

But Regence's vice president of provider services Alison Goldwater defended the policy in the Lund Report, saying that paying patients helps retain doctors in their network, particularly those who would otherwise terminate their contracts if Regence won't match their cost demands. She said some doctors have tried to charge as much as 10 times the Medicare rate for their services.

That's why Regence seeks to sign contracts with providers at agreed-upon prices and it excludes doctors who charge exorbitant rates. Tom Holt, a lobbyist for Regence, said in the article that such in-network contracts help prevent doctors from gouging insurers and patients with unsustainable charges and rate increases.

Blue Cross Blue Shield of Massachusetts has implemented a similar practice of reimbursing patients directly for ambulance services to help protect itself from inflated prices that can be up to 500 percent more than Medicare rates, FierceHealthPayer previously reported. 

To learn more:
- read the Lund Report article

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