Any-willing-provider law heads to Georgia Supreme Court

Doctors want clarity on a law they say was meant to guarantee patient choice.

By Amy Lynn Sorrel — Posted April 23, 2009

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Georgia physicians are marching to the state Supreme Court to defend the state's any-willing-provider law and stamp out an HMO's exclusionary tactics they say are illegal and menacing to patient care.

Northeast Georgia Cancer Care LLC sued Blue Cross and Blue Shield of Georgia in 2007 after the health plan refused to readmit the group's medical oncologists to its HMO network. The parties were in the process of renegotiating contracts after settling an earlier payment dispute. The Blues told Northeast Georgia Cancer Care that its HMO network was closed after giving an exclusive contract to another cancer group for oncology services.

The Northeast Georgia Cancer Care doctors alleged that such tactics violated the state's any-willing-provider law, which, like in most states, bars managed care entities from excluding physicians from their panels as long as the doctors meet the plan's criteria and contract terms.

The statute "was designed to give [patients] access to physicians they choose," the group's managing physician, oncologist Mark Vrana, MD, said in a statement. "That's what we are fighting for."

But in a March 26 opinion, the Georgia Court of Appeals said the dispute is one for state insurance regulators to decide, not the courts. Judges unanimously dismissed the doctors' case.

A trial court in February 2008 had ruled that the any-willing-provider statute did not apply to HMOs because they are subject to negotiating reimbursement rates with doctors in exchange for exclusive deals. But appeals court judges declined to interpret the law.

Northeast Georgia Cancer Care doctors said the court dodged the issue and are asking the Georgia Supreme Court to clarify the scope of the statute. The Medical Assn. of Georgia plans to get involved at the high court level via a friend-of-the-court brief. It would be up to the high court whether to accept the case.

"It is the policy of the state of Georgia to protect patients from managed care practices, to provide patients with the ability to choose their health care providers, and to promote the continuity of care. Application of the [any-willing-provider law] to HMOs serves these purposes," the medical society wrote in a brief filed earlier in the case.

The Blues plan maintains that the lower court rulings preserve the health plan's ability to manage its networks and meet patients' needs for access to care.

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