Blue Cross Blue Shield of Minnesota says it has referred its review of a local pain clinic to the FBI and the Minnesota Department of Commerce, even as the clinic owners say they haven't done anything wrong.
As of Oct. 1, Blue Cross ended its coverage for pain treatment at the Center for Pain Management, which has locations in Alexandria, Bemidji, Baxter and Sartell. That meant that patients with Blue Cross Blue Shield health insurance had to pay out of their own pockets to receive treatment at the center.
"We take seriously our responsibility to provide every member with access to safe, effective and high-quality care," Blue Cross said in a statement issued by a spokesperson. "Any decision to remove a provider from our network is not made lightly."
Center for Pain Management owners Dr. Sam Elghor and Dr. Jeffrey Anderson said they have not had a chance to address the insurer's complaints and that the clinic does its best to help patients with chronic pain. They said they are very concerned about their clinic's reputation and for patients who can no longer get insurance coverage.
“We have been for Blue Cross Blue Shield for 20 years,” they said. “We have never had any issues.”
ADVERTISEMENT
Blue Cross Blue Shield would not provide details about its findings, nor would the FBI or the Minnesota Department of Commerce, which cited the Minnesota Data Practices Act that protects data during ongoing investigations. Blue Cross did not answer an Echo Press question about how often it refers its findings to the FBI.
Elghor and Anderson wouldn't release the report they received from Blue Cross Blue Shield, saying they weren't sure if they had the legal right to do so.
However, they said the report contained three complaints that stem from a peer review, which is when the insurer hires a doctor to review a sample of a clinic's files, something that they said happens every three to six months.
They described the three complaints this way:
- Doctor's notes in patient files were on a template, which Anderson said are standard forms that can be modified for each patient, and that documentation of a physical examination was too vague.
- Some surgery patients who had to be sedated had complex medical problems and should have had their surgical procedures done at a hospital instead of at the Center for Pain Management.
- It seemed like the Center for Pain Management did not want patients to get better. Anderson said the summary phrased it this way: “It does not appear the provider is attempting to end these treatments because every visit documented a new vague complaint not documented on the previous visit.”
Elghor said the review looked at 24 patients out of thousands of patient encounters, and some took place after the pandemic started. They were trying to help patients with debilitating pain at a time doctors were focused on COVID, he said.
“We were doing everything we could to get patients out of the hospitals," he said. "The hospitals were overwhelmed.”
Their clinics are located throughout rural Minnesota and help those who would otherwise have to travel much further to get help, Elghor said. Some patients have been coming to them for many years, he said, and they have successfully steered many away from opioids.
They said they are the only clinic that they know of outside Fargo and St. Cloud that treats complex regional pain syndrome, a frustrating condition involving the nervous system that leads to incredible skin sensitivity to the point where some sufferers can't wear socks.
Anderson said they treat the most complex pain patients who often have been seen by primary care doctors or specialists, and provide a variety of procedures such as injections, epidurals, trigger points, spinal cord stimulation and sometimes opioids to relieve pain.
ADVERTISEMENT
"We believe that our clinic functions with integrity and the best interests of our patients,” Anderson said. “If there are issues, we would like to address them.”
Blue Cross said that whenever possible, it does 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 our members’ 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 said.
