CMA Seeking Clarification on Blue Shield Contract Amendment
[Posted 07/21/08]

CMA has received a number of calls from physicians concerned about a new Blue Shield contract amendment. The amendment, according to the notice, was issued in response to the California Department of Insurance’s new health care access regulations.

CMA’s review of the amendment has determined that the language in section 1B goes beyond the regulatory parameters. The CMA is seeking to ensure that the language is in line with California’s nondiscrimination laws and that physicians are not required to provide care that is not appropriate given their level of skill and specialty. CMA is concerned how this language may be interpreted and is working collaboratively with Blue Shield to minimize the adverse impact the language could have on physicians’ ability to practice medicine. Blue Shield has been responsive to physicians’ concerns and has committed to work with CMA to provide clarification shortly.

Physicians have also reported receiving a similar addendum from Health Net. CMA is reviewing the document and will provide additional information after the review is complete.

In addition to the specific questions raised by these amendments, CMA has concerns about the regulations themselves and has taken several steps to address both the underlying regulations and implementation efforts by insurers. CMA will be meeting with DOI soon to discuss these issues. Stay tuned for more information.

For more details:

• The contract amendment
• The cover letter

Contact: CMA’s Reimbursement Helpline 888/401-5911 or jblack@cmanet.org.