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ASCs in the News: California ASC in impasse with Anthem Blue Cross

Ambulatory Surgery Reimbursement Update, July 29, 2008

After mid-October, residents of Lodi, CA, may have to leave town to find outpatient surgery covered by Anthem Blue Cross. According to a July 11 article in the Lodi News-Sentinel, the Lodi Outpatient Surgical Center has announced that it cannot reach a reimbursement agreement with Anthem Blue Cross. The center’s contract with Anthem Blue Cross ends October 15. According to the News-Sentinel, the clinic provides a standard range of outpatient procedures such as cataract surgery, urological procedures and colonoscopies.

The ASC's administrator, Marklin Brown, told the newspaper that Anthem Blue Cross is a “very tough negotiator" that sought significant reductions in reimbursements to the clinic. "The premiums are high but their reimbursements to provider are not and it's time they see the light and start moving more money to their providers," Brown said. Residents with Blue Cross can find out-of-town providers or find another health insurance plan, Brown told the News Sentinel. And they may still seek treatment at Lodi Memorial Hospital or the outpatient center, according to the article, with the understanding that Blue Cross is unlikely to cover most costs.

Blue Cross spokeswoman Peggy Hinz told the News-Sentinel by e-mail that Anthem will continue to try to resolve differences with the ASC and the hospital. "We continue to negotiate with the Lodi Outpatient Surgical Center and are hopeful that we will reach a mutually acceptable agreement," she said.

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