Blue Cross Blue Shield of Minnesota on Oct. 1 ended its coverage for pain treatment at the Center for Pain Management and reported the clinic to the Federal Bureau of Investigation, the Echo Press reports.
The insurer also referred its review of the clinic to the Minnesota Department of Commerce but did not provide a reason for pulling coverage.
Since Oct. 1, patients have had to pay out of pocket to receive treatment at Center for Pain Management. It has clinics in Bemidji, Baxter, Sartell and Alexandria, Minn., where it also has an ASC.
Pain management specialists and owners of the practice Sam Elghor, MD, and Jeffrey Anderson, MD, told the Echo Press they have done no wrong and are concerned about their practice's reputation and their patients who no longer can get insurance coverage.
According to the report, the physicians said the complaints alleged that some patients who were sedated had complex medical issues and should have had surgery at a hospital; physician notes on patient files were on a template; the documentation of a physical exam was too vague; and many patient visits "documented a new vague complaint not documented on the previous visit."
The complaints stemmed from a peer review, which is typically conducted by a physician on behalf of the insurer every three to six months, according to the report.
Blue Cross and Blue Shield of Minnesota provided the following statement to Becker's:
"Blue Cross and Blue Shield of Minnesota continually assesses our provider network to ensure that our members have access to safe, effective and affordable care, and to verify that providers are billing appropriately for covered services. Any decision to remove a provider from our network is not made lightly.
"Center for Pain Management was terminated from the Blue Cross network — with cause — effective October 1, 2021. Blue Cross members who have recently received care from Center for Pain Management were also informed of this network status change. Due to peer review laws, we cannot disclose any details about the specific cause for termination at this time.
"Whenever possible, Blue Cross will address concerns with providers by implementing a plan of action that can be completed without any change in network status. However, when available data raises significant concerns about patient safety, Blue Cross has a responsibility to act quickly and focus on helping affected members find alternative in-network care options as soon as possible.
"Blue Cross is required to report the results of medical and billing practice reviews to multiple regulatory bodies when certain criteria are met. For legal reasons, we cannot disclose specific details regarding that process."
Center for Pain Management did not immediately respond to a request for comment Oct. 15.