Article - May 19, 2008 - American Medical News

AMA to help monitor Blues settlement
Physicians say the move will give them more leverage with the insurer

By Amy Lynn Sorrel

Physicians have another watchdog in their corner to help ensure the Blues stick to terms of a nationwide settlement over alleged payment abuses.

The American Medical Association recently joined 27 state medical societies to monitor compliance of the class-action agreement reached last year with 900,000 physicians, the Blue Cross Blue Shield Assn. and more than 30 Blues subsidiaries. The plans admitted no wrongdoing.

The AMA's participation came as part of final approval of the $130 million deal on April 19 by Judge Federico A. Moreno in the U.S. District Court for the Southern District of Florida in Miami.

The final provisions, many of which took effect April 21, allow the AMA to help doctors resolve claims disputes and other issues when a settling Blues plan fails to follow the business practice changes it consented to under the deal. Among those terms, the Blues agreed to revise their claims payment and coding procedures, implement medical necessity definitions, disclose fee schedules and ensure prompt reimbursement.

"The transparency and fairness mandated by this settlement will allow physicians to redirect their limited resources from battling for fair payment to caring for patients," AMA President Ron Davis, MD, said in a statement."The AMA stands ready to ensure physicians receive all the protections offered by the national BCBS settlement."

Doctors say the move will give them more leverage with the insurer, one of the nation's largest.

"The prospective relief is so important, and the AMA's participation is going to make the settlement provisions even more meaningful because the AMA is extremely knowledgeable about the issues impacting doctors," said Edith M. Kallas, the physicians' co-lead counsel.

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