Special E-Mail Bulletin
May 2002
Blues ordered to reveal fee schedule
Special E-Mail Bulletin
Hello, everyone.
One of the worst things about dealing with managed care plans is that some of them will try to force you to sign a provider agreement without revealing the complete fee schedule. If you're lucky they might give you the reimbursements on a few codes, but some plans simply won't give you any information. And so when you do get paid you have no idea if it's the right amount.
Here's some good news. Blue Cross/Blue Shield of Georgia has been ordered by the Superior Court to reveal its fee schedule to contracting physicians. Maybe this will be the start of a trend across the nation? Maybe at least with the Blues??
This story is from AMNews.
Gil Weber
Georgia Blues must open fee schedule
Latest court action declares physicians victorious.
By Julie A. Jacob, AMNews staff. May 27, 2002. Additional information
The Medical Assn. of Georgia has won its lawsuit against Blue Cross and Blue Shield of Georgia, in which the medical society sought to require the insurer to disclose its physician fee schedule.
The Superior Court of Fulton County issued a final judgment on the lawsuit April 29, ordering the Georgia Blues by May 29 to publish its physician fee schedule and method of calculating payments to physicians participating in its health plans.
The AMA, whose Litigation Center and Private Sector Advocacy group helped the Georgia association with legal strategy and financing of the lawsuit, said this was the first case it knew of in which a health plan had been forced to reveal in advance how much it would pay physicians for their services.
The Georgia Blues, a division of Thousand Oaks, Calif.-based WellPoint Health Systems, had no comment on the case.
MAG filed a lawsuit against the Georgia Blues in 1997 over the insurer's refusal to provide participating physicians with its fee schedule and method of calculating payments to physicians. A trial court ruled in favor of the Georgia Blues, but in January 2001 the Georgia Court of Appeals reversed the trial court's decision and ruled that physicians had a right to know the fee schedule and how the insurer was calculating its payments to physicians.
The case was sent back to the Superior Court of Fulton County for a final order.
MAG Executive Director David Cook stated that the lawsuit "has drawn national attention and sets a precedent for all insurers regarding fair business practices."
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