Atlanta – Insurance Commissioner Ralph Hudgens has required Blue Cross Blue Shield of Georgia to immediately rescind recent amendments to their existing physician contracts.
Commissioner Hudgens’ action comes in response to numerous complaints from physician regarding the insurer’s amendments to existing contracts. Complaints focused on lack of clarity in the terms of the contract, including the actual amount doctors would be reimbursed for providing medical services.
“I heard from doctors all over the state about the heavy handed approach taken by Blue Cross regarding their contract changes,“ Hudgens said. “I want doctors spending time caring for their patients, not being stonewalled by an insurance company.”
Common complaints include:
• The sample fee schedule did not accurately reflect the actual reimbursement rates.
• Doctors indicated that when calling Blue Cross for clarification, answers were not responsive including requests to obtain the actual full reimbursement schedule.
• Doctors reported that when they contacted provider representatives at Blue Cross they were told several practices received the amendment, but should not have. Other providers reported being told the opposite.
“This action resets the process while at the same time preserving the existing physician agreements without the amendments,” Hudgens said. “Georgia consumers will have continuous access to their Blue Cross contracted doctors and will not be impacted by this action.”
Hudgens’ action requires Blue Cross to:
• File the proposed amendments with his office for review prior to implementation:
• Provide doctors with accurate and complete reimbursement schedules;
• Provide notice by certified mail to doctors of the proposed contract amendments; and
• Ensure that all contract changes comply with Georgia Law.
Once filed, the Department of Insurance will have up to 60 days to review the contract amendments for compliance with Georgia Law.
