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Tuesday, Aug 16, 2022
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Hospital Sues Blue Cross for Policy Change

By CHRIS COATES Staff Reporter The California Hospital Association is suing Woodland Hills-based Blue Cross of California alleging that a new payment policy forces doctors to make medical decisions based on financial considerations. The suit contends a Blue Cross policy to be introduced in July would penalize doctors who perform colonoscopies in outpatient facilities by cutting their payment by 20 percent. The same procedure performed in a doctor’s office or ambulatory center would net a 5 percent return plus the full fee for the procedure. By reducing doctors’ fees, the lawsuit alleges that Blue Cross is giving doctors a financial incentive to restrict medical procedures as an option for their patients. “State law is quite clear health plans shouldn’t force doctors to make patient care decisions based upon money,” said California Hospital Association President C. Duane Dauner in a statement. “Doctors should be able to make decisions based on what is in the best interests of their patients.” The litigation, filed in Los Angeles County Superior Court, also charges that the policy violates state regulations that require doctors to make medical decisions void of any financial considerations and makes it illegal to entice doctors to limit services. The suit seeks an injunction to halt the policy’s planned introduction in July. Robert Alaniz, a spokesman for WellPoint, which owns Blue Cross of California, said the suit is frivolous. “From our perspective, this is a lawsuit about money,” he said. “Hospitals are losing money to ambulatory services.” Alaniz added that colonoscopies are procedures that can be safely performed in outpatient centers for around $500. Hospitals charge upwards of $6,000 for the same procedure, he said. By charging less, Alaniz said, Blue Cross is making the preventative procedure affordable to more people. “Cost is a big issue and its one of the propitiators for people to get colonoscopies,” he said.

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