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Blue Cross Blue Shield of North Carolina fights hospitals and providers for overcharging patients

July 20, 2012

Blue Cross Blue Shield seems to be on the forefront of health news lately and it seems they are especially  interested in reducing waste in the health industry. Last week BCBS of North Carolina entered into a high-stakes battle with the state’s hospitals, doctors and medical professionals saying “providers were overcharging patients and their insurers by $16 million dollars.”

Blue Cross is claiming that providers are “unbundling” procedures like radiology imaging and blood and urine test procedures and charging an identical fee for every image taken or for multiple tests done to the blood/urine even though there was only one procedure conducted.

In the article, “Blue Cross battles NC hospitals, health care providers over ‘wasteful’ radiology charges,” Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance, called the radiology billing method a classic example of “unbundling,” a widespread practice in which hospitals and other medical providers bill multiple times for a service that in reality is provided only once.

The uninsured and underinsured are the patients hurt worst by the practice, Anderson said. “If you don’t have someone negotiating on your behalf, they’re going to unbundle to the maximum extent possible,” he said. This radiology dispute is a small but revealing example of how arcane billing practices can drive up health care costs, which have been rising faster than inflation, even during the Great Recession. In particular, major urban hospitals in North Carolina have made record profits in recent years, raising their prices each year and exerting growing market power to negotiate higher payments from insurance companies. Read More…

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