{"id":266621,"date":"2025-11-02T09:13:39","date_gmt":"2025-11-02T09:13:39","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/266621\/"},"modified":"2025-11-02T09:13:39","modified_gmt":"2025-11-02T09:13:39","slug":"blue-cross-new-algorithm-for-health-care-costs-infuriates-doctors","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/266621\/","title":{"rendered":"Blue Cross&#8217; new algorithm for health care costs infuriates doctors"},"content":{"rendered":"<p>With the help of a computer algorithm, Massachusetts\u2019 biggest health insurer says it will scrutinize doctors who frequently bill it for the most expensive patient visits. It will then unilaterally cut payments to physicians it concludes charged too much.<\/p>\n<p>Targeting what it described as a small percentage of \u201coutliers,\u201d<a href=\"https:\/\/archive.ph\/o\/VlnRc\/https:\/\/www.bostonglobe.com\/2025\/10\/09\/business\/blue-cross-buyouts-health-care\/?p1=Article_Inline_Text_Link\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">\u00a0Blue Cross Blue Shield of Massachusetts\u00a0<\/a>plans to roll out the new program around Nov. 3. The insurer says\u00a0<a href=\"https:\/\/archive.ph\/o\/VlnRc\/https:\/\/www.bostonglobe.com\/2025\/10\/20\/business\/point32health-layoffs\/?p1=Article_Inline_Text_Link\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">health care costs are increasing\u00a0<\/a>at their fastest rate in more than 20 years and that it has a duty to help control them for its 3 million members.<\/p>\n<p>But the move has angered some doctors, particularly those who often\u00a0<a href=\"https:\/\/archive.ph\/o\/VlnRc\/https:\/\/www.bostonglobe.com\/2025\/10\/19\/business\/medicare-advantage-health-care-insurance\/?p1=Article_Inline_Text_Link\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">see older, medically complicated patients<\/a>\u00a0in need of more care and time. They say Blue Cross\u2019s initiative fails to recognize a simple fact of medicine: Patients and treatments don\u2019t fit neatly into categories used by insurers and software developers.<\/p>\n<p class=\"restricted-text\">STAT+ Exclusive Story<\/p>\n<p class=\"restricted-login\">Already have an account? <a href=\"https:\/\/www.statnews.com\/login\/\" data-stat-login=\"\" data-stat-paywall-cta=\"breaker login cta\" rel=\"nofollow noopener\" target=\"_blank\">Log in<\/a><\/p>\n<p>\t\t\t<img decoding=\"async\" class=\"restricted-content-breaker-bg\" src=\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/07\/stat-plus-breaker-bg.png\" alt=\"STAT+\"\/><\/p>\n<p>\t\t\t\t\t<a href=\"https:\/\/www.statnews.com\/stat-plus\/\" rel=\"nofollow noopener\" target=\"_blank\"><br \/>\n\t\t\t\t\t\t<img decoding=\"async\" class=\"stat-plus-logo\" src=\"https:\/\/www.statnews.com\/wp-content\/themes\/stat\/images\/stat-plus-logo-white.svg\" alt=\"STAT+\"\/><br \/>\n\t\t\t\t\t<\/a><\/p>\n<p>\t\t\t\tThis article is exclusive to STAT+ subscribers<br \/>\n\t\t\t\tUnlock this article \u2014 and get additional analysis of the financial innards of our health care system \u2014 by subscribing to STAT+.<\/p>\n<p class=\"restricted-content-breaker-wrapper-cta mobile\">Already have an account? <a href=\"https:\/\/www.statnews.com\/login\/\" data-stat-login=\"\" data-stat-paywall-cta=\"breaker login cta mobile\" rel=\"nofollow noopener\" target=\"_blank\">Log in<\/a><\/p>\n<p>\t\t\t\t\t\tIndividual plans<\/p>\n<p>\t\t\t\t\t\tGroup plans<\/p>\n<p>\t\t\t\t<a href=\"https:\/\/www.statnews.com\/stat-plus\/\" class=\"stat-button view-all\" data-stat-paywall-cta=\"breaker view all plans\" aria-label=\"View All Plans\" rel=\"nofollow noopener\" target=\"_blank\">View All Plans<\/a><\/p>\n<p class=\"restricted-content-text\">\n\t\t\t\t\t\tTo read the rest of this story subscribe to STAT+.\t\t\t\t\t<\/p>\n<p>\t\t\t\t\t<a href=\"https:\/\/www.statnews.com\/stat-plus\/\" class=\"stat-button restricted-button\" data-stat-paywall-cta=\"breaker subscribe cta 1\" rel=\"nofollow noopener\" target=\"_blank\">Subscribe<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"With the help of a computer algorithm, Massachusetts\u2019 biggest health insurer says it will scrutinize doctors who frequently&hellip;\n","protected":false},"author":2,"featured_media":266622,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,9041,253,1343,5599,248],"class_list":["post-266621","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-health","tag-health-care","tag-health-insurance","tag-healthcare","tag-policy","tag-public-health","tag-stat"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/266621","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=266621"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/266621\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/266622"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=266621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=266621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=266621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}