N.C. Blues sued over contract rights
NEWS IN BRIEF — Posted Jan. 19, 2004
A North Carolina physicians group late last year filed a lawsuit against BlueCross BlueShield of North Carolina, questioning the insurers' decision to extend certain contract rights to self-insured plans that they administer but do not have a payment responsibility for.
The Piedmont Community Physicians claim that physicians in their group who have contracted with the North Carolina Blues have not agreed to "discount fees for services to any person that is not properly enrolled in a BCBSNC product issued and underwritten by BCBSNC or a licensee of the association. Specifically, they have not agreed to provide services or extend any discounts to participants of self-insured employer plans that are merely administered by BCBSNC."
The lawsuit, filed in Orange County, N.C., asks that the court not allow the Blues group to extend the discounts to self-insured plans. Blues plan spokeswoman Michelle Douglas said the company had the right to enter into arrangements on behalf of all clients, something it has done for decades.
"We believe we are in compliance with the contracts we have," she said. "We will vigorously defend against the lawsuit."
The case is expected to set a precedent for other physicians who have similar language in their contracts.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/01/19/prbf0119.htm.