As we reported in Alert last month, Blue Cross recently agreed to remove the most problematic provisions from its physician contracts. CMA is pleased to report that the insurer has also agreed to remove onerous provisions from the Prudent Buyer contract amendment issued earlier this year.

Among other things, the amendment stated that physicians would be subject to contract termination and legal action if physicians disclosed or discussed the terms of the amendment with any third party, which CMA interpreted to include even their own attorneys or business managers. The revised contract now simply states that physicians must keep the terms of the contract confidential. The penalties for disclosure have been removed.

The amendment also prevented physicians from renegotiating or terminating their agreements at any time during the three-year contract term. The revised contract now requires Blue Cross to give physicians 90 days prior notice of a material change to the contract and allows physicians to terminate the agreement prior to the change becoming effective, as required by California law.

Unfortunately, the amendment continues to prohibit physicians from closing their practice to new Blue Cross patients unless they also stop taking new patients from all other contracted health plans. CMA believes this provision is inconsistent with California law, which prohibits health plans from forcing physician to accept additional patients if, in the physician’s reasonable professional judgment, accepting additional patients would endanger patients’ access to, or continuity of care. CMA will continue to advocate for its removal.

These and other problematic provisions will not be included in new and renewing physician contracts, and Blue Cross has informed CMA that it will not enforce these provisions in existing contracts.

Contact: Aileen Wetzel, 916/551-2037 or awetzel@cmanet.org.