Outpatient Surgery Centers Criticized for Overbilling Practices

Patients and insurers are criticizing outpatient surgery centers in California and across the U.S. for engaging in excessive billing practices, the Los Angeles Times reports.

Example of Excessive Billing Practices

The Times reports that Advanced Surgical Partners in Costa Mesa charged Lynne Nielsen -- a 61-year-old patient -- $87,500 for a knee operation that usually costs about $3,000.

Nielsen asked the California attorney general's office to investigate the center's billing practices. Advanced Surgical has since acknowledged that the bill was excessive.  Blue Shield of California -- Nielsen's insurer -- said that the surgery center eventually agreed to accept $15,000 for the procedure.

Criticisms of Billing Practices

Health industry experts say that some outpatient surgery centers intentionally seek out well-insured patients by waiving copayments and deductibles and then billing their insurers exorbitant amounts for out-of-network care.

Gerald Kominski -- director of the UCLA Center for Health Policy Research -- said, "This is an example of what's wrong with our health care system, and employees and taxpayers of" the school district that employs Nielsen "are paying the price here."

Steve Shivinsky -- spokesperson for Blue Shield -- said, "This surgery center is charging 30 times the average by remaining out of network to advance this outrageous and anti-consumer practice." He added, "This is a national problem."

Insurers Challenge Excessive Billing

The Times reports that insurers across the U.S. increasingly are challenging excessive billing practices from outpatient surgery centers.

In 2012, Aetna sued several surgery centers in Northern California, alleging that they overbilled the insurer by more than $20 million. It has made similar complaints against centers in New Jersey and Texas.

UnitedHealth Group also has filed similar suits in California.

Surgery Centers Respond

The surgery centers argue that the criticisms are unjustified.

Surgery center staff and officials say that the facilities have helped curb health care costs by offering convenient care at a fraction of what hospitals would charge for certain surgeries, such as colonoscopies and cataract procedures.