Insurance company Aetna is suing seven California surgery centers for a billing system that the payor claims "recklessly subverts" healthcare delivery by allegedly overcharging for certain services, according to a Bloomberg Businessweek report.
Aetna is suing to prevent the centers from waiving co-insurance payments that patients are supposed to be charged when they use out-of-network physicians or facilities. The company is saying the centers illegally lured patients by not requiring co-payments for out-of-network care and then billed Aetna up to 2,500 percent more than the payments for in-network providers.
Aetna alleges the centers shared the profits with the physician-owners at the facilities, incenting them to refer clients with the most generous insurance plans. The complaint names 11 defendants, including Bay Area Surgical Management and the six centers it manages.
Bobby Sarnevesht, a BASM executive, said the insurer is attempting to force BASM to sign a provider contract at unfairly low rates.
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Aetna is suing to prevent the centers from waiving co-insurance payments that patients are supposed to be charged when they use out-of-network physicians or facilities. The company is saying the centers illegally lured patients by not requiring co-payments for out-of-network care and then billed Aetna up to 2,500 percent more than the payments for in-network providers.
Aetna alleges the centers shared the profits with the physician-owners at the facilities, incenting them to refer clients with the most generous insurance plans. The complaint names 11 defendants, including Bay Area Surgical Management and the six centers it manages.
Bobby Sarnevesht, a BASM executive, said the insurer is attempting to force BASM to sign a provider contract at unfairly low rates.
Related Articles on Coding, Billing and Collections:
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