Business
Mich. societies sues Blues
NEWS IN BRIEF — Posted Sept. 27, 2004
The Michigan State Medical Society and the Michigan Osteopathic Assn. on Sept. 9 filed suit against BlueCross BlueShield of Michigan, charging that the payer is unfairly fixing prices for office visits by members of the United Auto Workers and their families.
The suit seeks a declaratory judgment from the Ingham County Circuit Court affirming that doctors do not have to charge discounted fees set by the Blues plan for office visits because UAW workers must pay 100% co-payments or meet very high deductibles for the visits under newly negotiated PPO contracts. The medical societies argue that under such circumstances the health plan is falsely claiming that these office visits are "covered benefits," and mandating adherence to the fee schedule, even though no actual benefits are typically received.
The medical societies want to be guaranteed that doctors who decline to accept the fee schedules will not be excluded from any of the Blues plans' PPO networks.
BlueCross BlueShield responded that doctors are obligated to the fee schedule to which they agreed when they signed what's called the Trust Network Agreement. It covers more than 1 million patients enrolled in several different Blue Cross PPOs.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/09/27/bibf0927.htm.
