Physicians should be aware that even though Blue Cross has an “all products” clause in its Prudent Buyer contract, the plan agreed as part of its RICO settlement with CMA that it would not require physicians to participate in its Workers’ Compensation networks. Physicians who do not wish to participate in these networks can opt out by notifying Blue Cross in writing by January 21. Physicians who opt out will still be free to negotiate separate contracts with Blue Cross to provide workers’ comp services.

Even though providers are required to give notice by January 21, 2007, that election will not become effective until January 21, 2008. Until then, all Prudent Buyer providers will continue to be obligated by their Prudent Buyer contracts to treat Blue Cross patients with work-related injuries and illnesses.

This opt-out right does not apply to physicians or physician groups that have any contract other than the standard Prudent Buyer contract, or an addendum to the standard contract that is specifically related to the provision of medical services for work-related injuries and illnesses.

Newly contracting physicians and groups will be given the opportunity to opt-out of Blue Cross’s Workers’ Comp networks at the time the contract is executed.

Blue Cross also confirmed in the RICO settlement that physicians with Prudent Buyer contracts who participate in other workers’ comp networks (MPN) can provide services to injured workers under the other MPN contracts and are not required to refer those patients to Blue Cross participating physicians.

Visit the RICO Resource Center for more information.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.