Rhode Island Blues plan ups reimbursements

On the heels of the resignation of its CEO and amid a fever pitch of discontent among the medical community over low payments, BlueCross BlueShield of Rhode Island said it would spend $100 million over the next two years to increase the reimbursements it pays to doctors and other health care professionals.

The boost in pay for physicians -- the first general increase in well over a decade -- will kick in Aug. 1 and will guarantee that doctors are paid at or above Medicare reimbursement levels for all the care they provide, said Scott Fraser, a Blues spokesman.

Payments to doctors will be increased to Medicare levels for those CPT codes that currently pay less, Fraser said. Pay for procedures that are already paid at or above Medicare levels will remain the same.

Taking into account all CPT codes, the Blues plan at present pays doctors an average of 85% of Medicare rates, said Newell E. Warde, executive director of the Rhode Island Medical Society. The revised Blues plan fee schedule is expected to increase that average to about 104%, he said.

Doctors are cautiously optimistic that the long-awaited pay increase is a signal that poor relations between doctors and the Blues plans are beginning to mend, Warde said. But he added that even after the planned increase takes effect, doctors in Rhode Island will significantly lag behind their counterparts in other New England states.

Fraser acknowledged that a November 2003 consultant's study, commissioned by the Blues plan, showed that physicians in Rhode Island receive lower reimbursements than doctors elsewhere in the Northeast.

Miserly reimbursement was a major complaint from doctors this year as the medical society and other health professionals' groups called for the firing of Ronald A. Battista, the plan's chief executive officer. Battista, the head of the plan since 1999, agreed to quit May 19 amid growing accusations that the insurer was spending money unwisely, taking advantage of its position as the dominant payer in the state, and not taking doctors' unhappiness with the plan seriously.