California Physician

A few months ago, CMA sent a letter to Blue Cross of California, objecting to misleading information on balance billing published in its January issue of PPO Network News.

The newsletter stated that “except for applicable copayments and deductibles, a physician shall not invoice or balance bill a Blue Cross member for the difference between a physician’s billed charges and the reimbursement paid by Blue Cross for any covered benefit.” CMA’s letter pointed out that while California law does prohibit contracting physicians from balance billing patients for covered services, there is no restriction on balance billing by noncontracting physicians. The letter asked Blue Cross to issue a correction.

Blue Cross refused. In a letter to CMA, Blue Cross Vice President and Corporate Medical Director Jeff Kamil, M.D., said the health plan’s newsletter targets and is sent only to PPO providers listed in the plan’s contracting provider database and therefore “Blue Cross does not believe any clarification is necessary or appropriate.”

CMA’s letter had pointed out, however, that not only did noncontracting physicians receive the newsletter, but other content in that same newsletter was clearly intended for noncontracting physicians. “The fact that the newsletter includes a lengthy description of how noncontracting physicians can access Blue Cross’s dispute mechanism leads CMA to the conclusion that contracting and noncontracting providers were the intended recipients of this correspondence,” wrote CMA Past President Ronald Bangasser, M.D., in CMA’s letter.

To learn the real story on balance billing by noncontracting physicians go to CMA ON-CALL document #0130, “Noncontracting Physicians/Implied Contracts.” ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 a page from the CMA Bookstore.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.