Enforcing the Blues settlement

The latest settlement of a class-action lawsuit over health insurers' contentious business practices gives physicians some extra assistance in holding insurers to their word about being more transparent and fair in contracting.

The help comes from the American Medical Association, which for the first time has gotten court approval to be a signatory medical society on a health plan settlement.

Signatory status gives the AMA official standing in monitoring whether the national BlueCross BlueShield Assn. and any of the 30 Blues plans and subsidiaries -- representing 90% of the Blues population -- are staying true to their deal. It also means that the AMA can provide the physicians with extra leverage to get something done when a Blues plan is not in compliance.

The AMA is joining 27 other state and specialty societies in signing onto the settlement, approved April 19 by U.S. District Court Judge Federico A. Moreno in Miami. Like past settlements with Aetna, Cigna, Health Net and WellPoint, the Blues agreement attempts to remedy previous abuses while making sure future dealings are fairer to physicians.

The Blues were ordered to pay out $130 million to physicians and revise their claims payment and coding guidelines, implement medical necessity definitions, disclose fee schedules, revise physician credentialing procedures and ensure prompt payment.

The terms were scheduled to be finalized shortly after AMNews press time, assuming that no appeals were filed, although the agreement is in effect as of April 21. Also as of press time, there was no word on how the cash settlement would be distributed among doctors.

For all physicians, the AMA is providing resources on its health plan settlement Web site to make it easier for physicians to find out more about the Blues deal (link).

The settlement site includes an interactive U.S. map. Click on a state, and you get information on which Blues plans are participating, and state-specific provisions of the settlement.

The site also includes a summary of the key settlement provisions, information on how to contact the AMA Private Sector Advocacy Practice Management Center for questions or assistance, and links to other information and resources, including details on past settlements with other plans.

For AMA members, there is more help available. The Practice Management Center can fill out a complaint form on behalf of an AMA member physician -- just as other signatory medical societies can complete forms on behalf of their members.

This gives doctors access to expertise that can present the most effective case. It also shields a physician from having his or her own name on the form.

This has been an impediment to getting doctors, fearful of retaliation, to file complaints for perceived violations of other settlements. Nonmember physicians who wish to file complaints can get AMA assistance regarding their forms, though they must fill them out and submit them.

The process of collecting on what's due to individual doctors and making sure that the broader provisions of the agreement are carried out benefits from the knowledgeable attention of organized medicine. The AMA's signatory status now gives physicians added oversight and assistance in achieving those objectives.