Profession
Court: Georgia HMO not subject to any-willing-provider law
NEWS IN BRIEF — Posted April 21, 2008
Georgia physicians are fighting to overturn a trial court decision rejecting their claims that the state Blues illegally excluded some doctors from its HMO network. Physicians say the ruling, if allowed to stand, could jeopardize access to care.
Last July, Northeast Georgia Cancer Care LLC sued BlueCross BlueShield of Georgia after the company refused to readmit the group's medical oncologists to its HMO network. Doctors said such tactics violate the state's any-willing-provider law, which prohibits managed care entities from excluding reputable doctors who are willing to accept a plan's terms, according to a friend-of-the-court brief the Medical Assn. of Georgia filed in the case.
But the Superior Court of Athens-Clarke County in February said the statute did not apply to HMOs, which must negotiate reimbursement rates with doctors in exchange for exclusive contracts. Giving physicians the ability to demand admission into the networks would "allow providers to push the hand of insurers while ultimately putting the patients at risk," the court said.
Northeast Georgia Cancer Care appealed the decision in March. No hearing date was set. The state medical association said it plans to file another brief at the appellate level.
The Blues said the ruling allows it to staff its networks appropriately to meet patients' needs.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/04/21/prbf0421.htm.
