Minnesota’s hospitals are calling for an investigation of one of the state’s largest insurers.
Blue Cross Blue Shield of Minnesota has increased the number of services it will refuse pay for without prior authorization, the Minnesota Hospital Association charged in a news release Monday, July 15.
It’s asking Minnesota Attorney General Keith Ellison and commissioners of the Minnesota Departments of Commerce and Health to investigate what it calls Blue Cross’ refusal to pay for "certain medically necessary services."
“Recent actions by Blue Cross are coming between physicians and their patients, delaying necessary medical care and driving up the cost of health care in Minnesota,” said Lawrence Massa, president and CEO of the hospital group, in a statement.
In response, Blue Cross Blue Shield said it’s merely begun to enforce a contractual requirement established in 2015 calling for prior authorization for specific health services.
“Similar prior authorization practices are implemented by other payers in Minnesota and across the nation to ensure patients receive care that is medically necessary and evidence-based,” said Jim McManus, the insurer’s director of public relations, in a statement.
The policy is a part of Blue Cross’ efforts to reduce health costs, McManus said.
“Physician and hospital costs represent the majority of every health care dollar spent,” he said. “We believe it’s important to take action that can help keep care and coverage affordable.”
But the hospital association argues the prior authorization process is harmful, requiring providers and patients to spend “countless hours” online or to be placed on hold waiting for the insurer’s subcontractors to respond to calls. That can cause a delay of as much as two weeks, according to the news release.
Massa said the hospital association has “sought multiple collaborative approaches” to resolve the issues, but said instead that the harms “continue and are growing.”
But McManus responded that Blue Cross began informational meetings on the subject with health care providers and the hospital association more than a year ago.
The hospital association also objected to a policy Blue Cross implemented earlier this year of refusing to cover colonoscopies in certain locations.
But McManus said Blue Cross’ policy is identical to a policy implemented by the Centers for Medicare and Medicaid for Medicare members.
“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,” McManus said.
The Minnesota Hospital Association represents 141 hospitals and health systems.
Blue Cross is the largest Minnesota-based health plan.