SPECIALIST REFERRALS: CALIFORNIA BLUE SHIELD’S NEW POLICY
"Abandoning a cornerstone strategy of health maintenanceThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
organizations for controlling medical costs," Blue Shield of
California announced yesterday that it will allow enrollees to go
directly to a specialist without a primary care doctor's
referral, LOS ANGELES TIMES reports. Members will be allowed to
make an unlimited number of self-referrals to specialists within
their chosen medical group for an extra $20 fee on top of Blue
Shield's $10 copayment. However, enrollees will not be allowed
to self-refer for laboratory tests or surgical procedures. The
new program, which TIMES notes is "a first in California and rare
among HMOs nationally," will go into effect September 1 for Blue
Shield's 325,000 members.
ANSWERING CONSUMERS: Blue Shield Chair/CEO Wayne Moon,
explaining the reason for the health plan's "aggressive move,"
said, "What we hear loud and clear from consumers is that they
are less satisfied with their access to specialty care, and they
experience increased anxiety when there is no flexibility to see
a specialist." Blue Shield noted that customer surveys have
shown that 15% to 25% of HMO members are dissatisfied with their
access to specialist care. TIMES notes that Blue Shield's move
is likely to place pressure on other HMOs to do the same. Alan
Katz, a principal at Centerstone Insurance, a large, Woodland
Hills, CA-based insurance broker said, "This is one of the
earliest examples of what the marketplace is forcing HMOs to do.
Twenty dollars may still be a lot of money for some people. But
for the peace of mind that your child's illness has been looked
over carefully by a specialist, most families would be able to
find the money."
REAX: While health care experts "generally praised" Blue
Shield's new referral policy, they also "questioned" whether the
company will be able to control costs as effectively as its
competitors. But Blue Shield representatives said that the
program "should not significantly boost medical costs or lead to
increased member premiums." They said that company actuaries
have estimated a "minimal increase" in the use of specialists