ASCs sue over lack of spine surgery reimbursement

Editor's Note

According to the February 2 Becker’s ASC Review, two ambulatory surgery centers (ASCs) recently filed lawsuits against insurance payers over reimbursement, or lack thereof, for spinal procedures.

Surgery Center of Viera, based in Melbourne, Florida, filed its lawsuit January 20 against Cigna and consulting services Strategic Enterprise Solutions for reimbursement of a spinal procedure in the amount of $434,000. In the lawsuit, Surgery Center of Viera alleges that Cigna only reimbursed $75,000 for a procedure deemed “medically necessary” to help a patient with “chronic…debilitating back pain.”

The second, Center for Pain Management in Alexandria, Minnesota, seeks to solve a dispute that excluded the center from Blue Cross and Blue Shield of Minnesotane surgery reimbursement’s network. The insurance payer’s stance is that spinal procedures should be conducted at hospitals. The Center for Pain Management is refuting this stance, arguing that patients “received transforaminal epidural steroid injections or radiofrequency ablation” at the center “without complications.”

ASCs have sought to increasingly establish more complex service lines to compete for hospital ORs and provide a different outpatient experience to patients who might not need to be admitted into hospitals for procedures. OR Manager has recently reported on this activity; read the full stories on how ASCs have worked to implement more cardiology services and spinal procedures here and here.