Blue Cross officials on Friday rejected the allegation that they established new policies and procedures with the specific intent of denying or delaying needed care. Rather, the not-for-profit insurer said it is working with a for-profit contractor in South Carolina called eviCore to enforce evidence-based guidelines for approving and paying for care. But sometimes that does result in denials.
To hospitals and some Blue Cross customers, the aggressive denials seen this year are tantamount to fraud and deception, since members can’t access the benefits purchased by them or on their behalf. Minnesota Attorney General Keith Ellison’s office is looking into the hospitals’ concerns, after receiving a formal complaint from the Minnesota Hospital Association earlier this week.