Corporate Compliance

Another insurer joins the list of those refusing to pay for 'never events'

Compliance Monitor, July 23, 2008

Blue Cross and Blue Shield of Kansas City became the latest health insurer to announce it will no longer cover medical costs that result from certain preventable errors.
 
Several private insurers, including CIGNA, WellPoint, and Aetna, made similar statements after Medicare announced, in August 2007, it would stop paying for eight preventable complications, also known as “never events” starting on October 1, 2008. Medicare expanded the list in April by proposing the addition of nine more “never events” to the list.
 
In addition to private insurers refusing to pay for never events, hospitals in Pennsylvania, Massachusetts, Minnesota, and Washington have agreed not to charge for all never events. Hospitals in other states have agreed not to charge for some never events.
 
According to an article in the Kansas City Star, Blue Cross and Blue Shield of Kansas City will use the same list of “never events” Medicare is planning to use.
 

The proposed complications no longer covered by Medicare include:

  • Sudden artery blockage, or embolism, from air bubbles introduced during surgery.
  • Objects left inside a patient during surgery
  • Use of the wrong blood type during transfusions
  • Urinary tract infections associated with catheters
  • Pressure ulcers (bed sores)
  • Infections from central vein catheters
  • Mediastinitis, an often fatal surgical-site infection of lung tissue
  • Hospital-acquired injuries, such as fractures, dislocations, head and crushing injuries, and burns
This list could change before the October 1 implementation date, and Blue Cross and Blue Shield of Kansas City said it will change its list if Medicare adds or removes any never events from its list.
 
To read the full article, click here.

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