Alabama MDs say state Blue plan hasn't followed class-action agreement

Working with 20 specialist physicians and practices, the Medical Association of the State of Alabama has filed formal complaints arguing that Blue Cross and Blue Shield of Alabama hasn't been following the terms of a class-action settlement.

The settlement, which took place in 2007, regarded payment practices of 30 health plans affiliated with the BlueCross BlueShield Association, including the Alabama plan. Physicians say that the Alabama Blue plan has failed to give doctors enough notice of planned fee schedule changes, has not paid for claims including CPT modifiers 25 and 59, and has never formed a specialty physician advisory committee as required by the agreement.

Settling this matter is particularly important to physicians given that the Alabama Blues hold an estimated 89 percent market share in the state, according to AMA projections. That makes the plans the dominant single-state health insurer within the states tracked by the AMA.

The complaint follows other controversies over compliance with the settlement agreement. In August, Independence Blue Cross of Pennsylvania was ruled to be in violation of the agreement when it attempted to collect what it deemed to be overpayments going out to surgeons.

For more information on the suit:
- read this American Medical News article

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