Survey Confirms Physicians Have the Blues Over the Blues April 27, 2012 Advocacy, CMA, Payment, SFMS Member AB 1742 0 As previously reported, CMA has received numerous complaints from physicians regarding Blue Cross and Blue Shield’s refusal to honor assignment of benefits, highlighting the burden and cost it places on the physician practice to act as debt collectors rather than physicians, and in many cases, this policy has jeopardized the physician-patient relationship. To address this issue, CMA sponsored AB 1742 (Pan) to shore up this loophole and require Blue Cross and Blue Shield, the major PPOs currently refusing to honor assignment of benefits, to pay physicians directly for out of network services. Representatives of Blue Cross and Blue Shield were asserting to the legislature a false claim that by removing the incentive of direct pay to the physician for out of network services, there would be a broad erosion of the PPO networks. In other words, they asserted that direct pay is the main reasons physicians decide to contract and if that option is removed, doctors will no longer contract with payors. CMA/SFMS conducted a survey on criteria physicians consider before signing a contract to be in a payor network. We had an overwhelming response to the survey, gathering over 1,100 responses from physician practices in 43 different counties within a very short period of time. Through the survey results, we were able to highlight the following to the legislature: The two most important factors physicians consider when deciding to join a payor network are fair reimbursement rates (78%) and low administrative hassle factor (35%) followed by fair contract terms/language (34%) and a payor’s market share in the area (28%). Only 5% of physicians report that the guarantee of direct payment from the payor is deciding factor. More than 8 in 10 physicians report that the payor’s policy of paying patients directly for out-of-network services has had a negative impact on patient care. Almost 100% of the respondents who experienced an instance of the payor paying the patient directly reported difficulty collecting from the patient. The failure of Blue Cross and Blue Shield to honor assignment of benefits is extremely costly for physician practices. 96% indicated there was a negative financial impact to the practice to collect from patients (e.g., lost revenue, administrative costs to collect, collection agency fees, lost follow-up business, etc.) when a payor refuses to honor assignment of benefits. 49% reported the financial impact of a payor sending payment directly to the patient is greater than $5,000 and 14% report it costs their practice more than $20,000 to try to collect when payment is sent to the patient. Though this specific bill is still in the Assembly Health Committee for reconsideration after failing passage earlier this week, our effort to require Blue Cross and Blue Shield to honor assignment of benefits will continue. The survey results will also aid our legislative efforts in support of physicians and patients on various issues. Click here to view the comprehensive survey results. Comments are closed.
