Blue Shield of California Eases Restrictions on Physician Reimbursement
Blue Shield of California yesterday announced plans to relax restrictions on reimbursements for physicians, "making it easier for the 35,000 doctors in its network to get paid," the San Diego Union-Tribune reports. Blue Shield said it is easing provisions that prohibit doctors from being reimbursed for services that were not preauthorized and will allow doctors to receive payment when a claim is being challenged by the health plan. In addition, Blue Shield will no longer require doctors to participate in all Blue Shield health plan models in order to be included in its preferred-provider network. Previously, doctors who wanted to participate in Blue Shield's preferred-provider network also had to participate in the health plan's HMO plan. The changes, part of an "ongoing peacemaking effort" with physicians, took effect yesterday. "We want to continue to nurture our relations with our physicians," Dr. Jeff Rideout, chief medical officer for Blue Shield, said, adding, "Contracts are something that need to be addressed on a continual basis." Dr. Jack Lewin, president of the California Medical Association, said, "On numerous important issues, Blue Shield's willingness to change the terms of the agreement reflect a clear commitment to work with physicians to achieve fair and equitable contractual relationships." However, he added, "I don't see this as a consistent effort with all health plans." Many health plans still impose "heavy-handed administration and low-paying contracts" on doctors, he said (Fong, San Diego Union-Tribune, 2/26).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.