The strenuous relationship between insurance providers and ASCs has taken another step lately. This is because some ASCs are working to drastically reduce their need for insurance providers through various means.
Over the past several years, insurers have placed increased pressure on ASCs and physicians to approve and receive payment for surgery by disputing more claims. In turn this has led to decreased efficiency and lower quality care. This is because ASCs have to work to convince insurer’s medical directors of the need for procedures.
Laura Dyrda of Becker’s adds that insurers struggle to pass ASC-friendly policies out of fear of disturbing relationships with hospitals and members.
“Even though insurers can experience substantial savings through the shift of the site of service to the ASC, they rarely approve pro-ASC policies or directives,” Greg DeConciliis, an administrator with Boston Out-Patient Surgical Suites told Becker’s. “Instead of embracing competition, they prevent it from occurring.”
With little help coming from insurers, some ASCs are looking to engage with larger employers directly. They are particularly looking toward those with self-funded medical plans. This direct relationship lessens the impact of third-party insurers, who may opt to dispute claims or deny clearance for procedures. Through this direct relationship, ASCs can provide care for patients and receive payments directly from the employer.
Becker’s adds that some centers have also moved toward a cash-payment bundle model. This allows an easier billing process without the use of third-party payors. This model is uncommon for the time being. However, it may be possible to see more locations opting to take this approach rather than continuing to fight against insurers.