A relatively small number of health insurance claims in Colorado led to an $8.2 million windfall for intraoperative neuromonitoring companies, according to a new study by Center for Improving Value in Health Care.
The review of more than 30,000 claims for intraoperative neuromonitoring by CIVHC follows a series of stories by 9Wants to Know outlining some questionable billing practices within the business of intraoperative neuromonitoring.
In one instance, a patient who underwent back surgery at Parker Adventist Hospital received a check for $169,600 from her insurance company to help pay for the intraoperative neuromonitoring done during her 2015 surgery.
In simple terms, intraoperative neuromonitoring involves utilizing technical equipment that should, in practice, help alert a surgeon if he or she is coming close to doing any long-term damage to the patient’s central nervous system.
Since airing our first story, 9Wants to Know has spoken to two other people who also received insurance checks more than $100,000 to help them pay for the monitoring done at Centura Health’s Parker Adventist. Centura Health, which does not own the monitoring companies that operate within its facilities, has since ordered an internal review of its relationships with the companies in light of the 9Wants to Know investigation.
CIVHC’s study of insurance claim data in Colorado found insurance companies paid more than $25,000 for intraoperative neuromonitoring on at least 130 occasions between 2013 and 2016. The average payment of those 130 claims was $63,077. The total paid on those claims came out to $8.2 million.
The numbers stand in stark contrast to what’s typically seen in the industry.
CIVHC’s data found the average payment by commercial insurance – when looking at more than 30,000 claims – turned out to be around $820.
Medicaid paid, on average, $110 for the monitoring. Medicare paid $100.
The data confirms a small number of claims continue to get paid at an exceptionally high rate. It remains unclear why, however, as insurance companies contacted by 9Wants to Know have, to date, failed to explain why they would, for example, pay more than $100,000 for a single claim when the average payment is typically less than a thousand bucks.
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