State Hospital Association sues Blue Cross over payment policy.The California Hospital Association has sued Blue Cross of California, seeking to block changes in the health plan's payment policy that the trade group says illegally interfere with a doctor's ability to make medical decisions based on the best interest of their patients. The lawsuit, which was filed in Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. County Superior Court on June 8, contends that Blue Cross is violating sections of the state's Insurance Code and the Knox-Keene Act, by providing doctors financial incentives to perform certain procedures in less expensive ambulatory Movable; revocable; subject to change; capable of alteration. An ambulatory court was the former name of the Court of King's Bench in England. It would convene wherever the king who presided over it could be found, moving its location as the king moved. centers, rather than a hospital-affiliated outpatient center. Under the change, set to take effect July 1, physicians who perform colonoscopies in a hospital facility would find their usual reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. cut by 20 percent, the hospital trade group said. Conversely con·verse 1 intr.v. con·versed, con·vers·ing, con·vers·es 1. To engage in a spoken exchange of thoughts, ideas, or feelings; talk. See Synonyms at speak. 2. , if the same procedure is performed in a physician's office or a stand-alone ambulatory center, the health plan will add 5 percent to the usual reimbursement. The suit argues that Blue Cross, a subsidiary of Indianapolis-based WellPoint Inc., is deceiving its members in order to boost corporate profits. "Our concern, first and foremost, is for patients," said CHA n. 1. Tea; - the Chinese (Mandarin) name, used generally in early works of travel, and now for a kind of rolled tea used in Central Asia. A pot with hot water . . . made with the powder of a certain herb called chaa, which is much esteemed. - Tr. J. President C. Duane Dauner in a statement. "We want to make sure that every man, woman and child in California receives the best medical care possible--not just the cheapest medical care," WellPoint spokesman Robert Alaniz called the suit frivolous Of minimal importance; legally worthless. A frivolous suit is one without any legal merit. In some cases, such an action might be brought in bad faith for the purpose of harrassing the defendant. . "We believe this is a lawsuit that is based on dollars and not patient safety," said Alaniz, adding that there is no data that colonoscopies performed in a hospital are any more or less safe than in an ambulatory center, and that he himself has safely had the procedure done in a standalone stand·a·lone adj. Self-contained and usually independently operating: a standalone computer terminal. center. Keeping the down the cost of such common procedures helps Blue Cross to limit premium increases to its members, Alaniz said. Colonoscopies can be safely performed in outpatient centers for around $500, he said, compared to as much as $6,000 in a hospital setting. By DEBORAH CROWE Staff Reporter |
|
||||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion