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Minnesota hospitals want Blue Cross probed over claim denials

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Blue Cross Blue Shield of Minnesota
In this file photo, the headquarters of Blue Cross and Blue Shield is pictured in Eagan.
Jim Mone | AP 2014

Updated 4:48 p.m. | Posted 2:36 p.m.

The state's hospital association is calling on Minnesota officials to review what the trade organization describes as Blue Cross Blue Shield of Minnesota's refusal to pay for "medically necessary services" even though the providers are members of the insurer's network.

Blue Cross's decision-making is "harming Minnesota's hospitals and clinics and their patients with BCBS insurance," the Minnesota Hospital Association said Monday as it called for an investigation into whether Blue Cross is "violating longstanding consumer protection laws."

The hospital group said Blue Cross "has dramatically increased the number of services it will not cover or pay for without a prior authorization before patients can receive necessary medical treatment." As an example, it cited a policy it will no longer pay for colonoscopies performed at certain hospitals based on where the hospital is located.

In December, Blue Cross announced changes restricting payment for colonoscopies and other procedures in hospitals that did not meet its medical policy criteria. Those new rules took effect in March.

Responding to the hospital group's criticisms, Blue Cross on Monday said it is obligated to guide members to clinics when they provide equal or better care than hospitals do for less cost. 

The company also said its prior authorization policy is in step with other insurers' practices and that hospitals have the option of matching outpatient clinic pricing.