Blue Shield Requires Physicians to Notify Patients Before Referring Out-of-Network March 27, 2013 Payment Blue Shield, managed care 0 On March 15, Blue Shield announced that it would soon begin requiring contracted physicians to notify patients in writing before making out-of-network referrals. Effective May 15, physicians will be required to notify patients in writing using a form provided by the payor when referring a patient to an out-of-network provider. The policy does not apply to emergencies. This change comes on the heels of a similar change recently implemented by Anthem Blue Cross. While existing language in Blue Shield provider contracts had placed limitations on referrals to out of network providers for patients with HMOs, EPOs, and/or Medicare Advantage plans, those limitations did not apply to patients with PPOs. That will change effective May 15. According to Blue Shield, the completed form must be filed in the patient’s medical record and be made available to Blue Shield within five business days if requested. The notice does not provide details on how Blue Shield intends to enforce this provision. The California Medical Association (CMA) has asked for clarification on this issue and will publish an update when available. California law states that if a physician objects to a material contract change, such as this, he or she has the right to terminate the contract prior to implementation of the change. According to the Blue Shield contract, physicians who object to a material change may terminate the agreement with 60 days written notice. If a termination notice is submitted within 60 days of receipt of the notice, the proposed changes will not apply during the 60-day termination period. Physicians with concerns are encouraged to contact the Blue Shield Provider Liaison Unit at (800) 258-3091. Questions about managed care contracts and payor issues? SFMS members receive one-on-one assistance from the Center for Economic Services via CMA’s reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. Comments are closed.
