Regence and Ambulatory Surgery Centers Reach Compromise
June 17, 2013 — A measure that would cramp down on an abusive payment practice to ambulatory surgical centers by Regence BlueCross BlueShield has been resurrected and attached in the House to another bill, Senate Bill 724, which passed the House on Friday.
Regence has been sending medical payment checks, sometimes without any accompanying paperwork, to policyholders, as part of a dispute over charges to out-of-network ambulatory surgery centers. This has forced the surgery centers to track down payments and send some patients to collections in order to get the money the insurer agrees to pay.
The “rider amendment” to SB 724 requires that insurance companies either bill the centers directly or send policyholders a check that requires a dual signature with the surgery center management before the bank will honor it.
SB 724 is the so-called “air-conditioner” bill, which authorizes the Oregon Health Authority to set up billing codes for non-traditional medical expenses like air conditioners and community health workers for patients receiving care through coordinated care organizations.
“I think it’s a great compromise,” said P. Evalyn Cole, the chief executive officer of KeiperSpine and Spine Surgery Center of Eugene. “It will prevent patients from cashing the check and keeping the money.”
Cole told The Lund Report that insurers send the check to the policyholder as opposed to the patient, meaning sometimes the checks have gone to out-of-state parents or to patients’ ex-husbands, including one who cashed a $48,000 check intended for his ex-wife and pocketed the money. She said the patient was still on the hook for paying the bill.
“She’s the one who will have to go through bankruptcy to get out of the debt,” said Cole.
Though Cole was pleased with the compromise, it’s possible ambulatory surgery centers may have trouble tracking down all of those checks and more legislation may be needed.
“We hope it works. We’ll be hearing from the ambulatory surgery centers if it doesn’t,” said Sen. Laurie Monnes Anderson, D-Gresham.
Sending checks to patients is banned outright in other states, including California. The amendment to SB 724 is a compromise from Senate Bill 366, which would have ended the practice of sending checks to patients entirely. SB 366 had a hearing in early March, but died in the Senate Health Committee, after it received some resistance from lawmakers.
Monnes Anderson said she wanted more time to work out a compromise that insurance companies could accept.
“The insurers needed to come to the table,” Monnes Anderson told The Lund Report.
She said there were more than 100 “anti-insurance” bills introduced this session, and she had trouble immediately determining which problems with insurers had merit.
Greg Miller, the lobbyist for Oregon Ambulatory Surgery Centers, also said Sen. Elizabeth Steiner Hayward, D-Beaverton, objected to the tremendous price difference between what Medicare pays for certain procedures and what the surgery centers charge.
Cole explained that their charges include items that are critical for younger people with sports injuries, but which Medicare refuses to cover for people over 65.
“None of our surgeries are on the Medicare-approved list, so we are at the mercy of whatever the insurers choose to pay out,” Cole said.
The ambulatory surgery centers tried to attach additional amendments that would help set a fair price for reimbursement, including one amendment that would have required insurers to pay them at 70 percent of their charges, but the House Health Committee balked at those amendments without further negotiations between the centers and insurance companies, who could not reach an agreement.
“There need to be some sideboards, otherwise you just raise the price through the ceiling,” Rep. Jim Thompson, R-Dallas, said at the May meeting of the Health Committee.
SB 724 passed the House unanimously, but since it was amended, it must be re-passed in the Senate where it had just one opponent in April, Republican Sen. Fred Girod of Stayton.