Here are four recent disputes involving ambulatory surgery centers and insurance companies over payments and in-network status.
1. The New Jersey Association of Ambulatory Surgery Centers recently sent a letter to the New Jersey Department of Banking and Insurance asking them to investigate Aetna's practice of redirecting in-network patients. Aetna has sent prospective patients and physicians letters informing them of cheaper, in-network alternatives to the in-network facilities where procedures were originally scheduled.
2. A group including nine California surgery centers and 60 physicians has sued Aetna, alleging the company reneged on medical benefits. The suit is the result of an escalating dispute over payments for care in facilities that are out-of-network with the insurance provider.
3. Two Chicago outpatient surgery centers that are part of American Health Care Centers, allege that Blue Cross & Blue Shield of Illinois reneged on "unambiguous promises" of coverage for services. Fullerton Kimball Medical & Surgical Center is seeking $9.9 million in fees for more than 1,100 services and West Diversey Surgical Center is seeking $595,000 in fees for more than 110 services.
4. Also in California, Aetna and UnitedHealthcare alleged that surgery center chain Bay Area Surgical Management fraudulently overcharged companies. Bay Area Surgical Management strongly denies these claims.
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1. The New Jersey Association of Ambulatory Surgery Centers recently sent a letter to the New Jersey Department of Banking and Insurance asking them to investigate Aetna's practice of redirecting in-network patients. Aetna has sent prospective patients and physicians letters informing them of cheaper, in-network alternatives to the in-network facilities where procedures were originally scheduled.
2. A group including nine California surgery centers and 60 physicians has sued Aetna, alleging the company reneged on medical benefits. The suit is the result of an escalating dispute over payments for care in facilities that are out-of-network with the insurance provider.
3. Two Chicago outpatient surgery centers that are part of American Health Care Centers, allege that Blue Cross & Blue Shield of Illinois reneged on "unambiguous promises" of coverage for services. Fullerton Kimball Medical & Surgical Center is seeking $9.9 million in fees for more than 1,100 services and West Diversey Surgical Center is seeking $595,000 in fees for more than 110 services.
4. Also in California, Aetna and UnitedHealthcare alleged that surgery center chain Bay Area Surgical Management fraudulently overcharged companies. Bay Area Surgical Management strongly denies these claims.
More Articles on Surgery Centers:
10 Surgery Center Leaders on Southeastern & Southwestern State Association Boards
8 Steps to Elevate Profitability at Surgery Centers
15 Statistics on Physician Compensation for Key Surgery Center Specialties