Physicians Urged to Read Carefully Before Signing
New Blue Cross Contract Amendment [Posted 05/12/08]
CMA has learned that many physicians renegotiating their contracts with Blue Cross of California have been asked to sign an amendment to the insurer’s Prudent Buyer Plan Participating Physician Agreement.
Before signing any new contract or contract amendment, it is critical that you review it carefully and make sure the terms of the agreement are mutually beneficial. This particular amendment contains several onerous provisions. For example,
Physicians can not close their practice to new Blue Cross patients unless they also stop taking new patients from all other contracted health plans.
Physicians are not allowed to disclose or discuss the terms of the amendment with anyone, even their own attorneys or business managers. Doing so will constitute a material breach of the agreement and Blue Cross may unilaterally and without notice reduce the physician’s fee schedule, terminate the agreement, and/or take legal action against the physician.
The contract term is 3 years and physicians do not have the right to renegotiate or terminate the agreement until the contract expires.
Physicians should also be aware that Blue Cross considers the amendment to be an “individually negotiated contract.” Physicians who sign individually negotiated contracts do not qualify for protection under the Wellpoint RICO settlement.
To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” The toolkit is available free to members at the members-only website, http://www.cmanet.org/member (click on “Reimbursement Advocacy” under “Physician Advocacy”). Nonmembers can purchase the toolkit for $100 in the CMA bookstore, http://www.cmanet.org/bookstore.
