EXTERNAL REVIEWS: Blue Shield Adopts Voluntary Reviews
As of yesterday, Blue Shield of California members with grievances regarding denial of services for medically necessary or experimental treatments can take their complaints to an independent, third-party review board. In keeping with a decision outlined in December by the California Association of Health Plans, Blue Shield adopted a voluntary external review system to resolve cases within 30 days -- or sooner when "the standard timeframe could jeopardize the health of the member." The CAHP decided that all member plans represented on the association board would be required to adopt review systems in 1999, and Blue Shield is the first California plan to adopt the system. "The external review process produces fair and binding decisions based on medical experts' review of medical evidence," said Dr. Al Martin, corporate medical director. Bruce Bodaken, president of Blue Shield of California and CAHP chair, was instrumental in convincing all association plans to adopt the system. "Blue Shield continues to support the passage of independent review legislation that puts this program in place for all California health plan members," he said. External review is currently available to all Blue Shield HMO members, and will be available to PPO members on July 1 (release, 5/3).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.