Health Insurers To Refuse Payment, Billing for Care Related to Hospital Errors.

January 15th, 2008

Several private health insurers, such as Aetna and WellPoint, have moved to end reimbursements to hospitals for treatment that results from serious medical errors, the Wall Street Journal reports. The insurers also will not allow their members to be billed for hospital errors.

Last year, CMS announced a rule under which Medicare after September no longer will reimburse hospitals for the treatment of bed sores, falls and six other preventable conditions that occur in the facilities. CMS next year plans to add to the list hospital-acquired infections, blood clots in legs and lungs, and pneumonia contracted from a ventilator.

In hospital contracts that require renewal, Aetna has begun to include a provision that ends reimbursements for 28 “never events” outlined by the National Quality Forum. In Virginia, WellPoint has begun to test a similar policy that ends reimbursements for four never events, and the company plans to expand the policy to Georgia, New England and New York in the near future. UnitedHealth Group and Cigna have considered policies similar to the CMS rule.

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