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BlueCross sued for paying docs in ASCs more than hospitals

Ambulatory Surgery Reimbursement Update, June 14, 2006

The California Hospital Association (CHA) is suing BlueCross of California over a policy the CHA claims will pay doctors performing endoscopies in ambulatory surgery centers (ASCs) more than they would receive for performing the same surgery in a hospital setting, according to the Associated Press (AP).

This policy, if followed, would violate state laws, the CHS said. It is scheduled to go into effect July 1.

The lawsuit claims that the policy would reward doctors performing endoscopies in ASCs by paying them their regular fee plus an additional 5%, with doctors performing endoscopies at a hospital seeing their fee reduced by 20%, according to the AP story.

"State law is quite clear [that] health plans shouldn't force doctors to make patient care decisions based upon money," CHA President C. Duane Dauner said in a statement, according to the AP. "Doctors should be able to make decisions based on what is in the best interests of their patients."

Robert Alaniz, spokesman for WellPoint Inc., the parent of BlueCross, dismissed the allegations. "From our perspective, this is a lawsuit that's really about dollars not about patient safety," Alaniz said, according to the AP. He said that 65% of colonscopies, the most common type of endoscopies, covered by BlueCross are already performed at ASCs.

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