Legislation that would ban the use of most-favored nation (MFN) clauses in managed care contracts saw some late action in the General Assembly’s 2012 Short Session. Despite strong support from the physician community, the bill ultimately did not pass. BlueCross and BlueShield of North Carolina (BCBSNC) was alone in opposing enactment of Senate Bill 517 – Freedom to Negotiate Health Care Rates.
Statements by BCBSNC on the Record
Although the bill went down, there is a silver lining here. In public, unsworn testimony to a House committee, a high-ranking BCBSNC representative made the following key statements:
- BCBSNC has not enforced MFN clauses for several years.
- BCBSNC will remove these clauses from old contracts at a provider’s request.
- If a provider requests that an MFN clause be removed, there will be no retaliation from BCBSNC, such as a reduction in payments.
- BCBSNC is not using MFN clauses in new contracts, and does not plan to use them in future contracts.
You can listen to a recording of the committee meeting, which includes BCBSNC’s statements, here.
Other North Carolina health plans that supported the legislation (including Aetna, CIGNA and United HealthCare) have signaled that they also oppose the use of MFN clauses in provider contracts, and may be willing to remove them upon request.
The Takeaway
Physicians and medical practices that hold network participation contracts with BCBSNC may be affected. As stated above, if an MFN clause exists in your contract, BCBSNC has indicated that the clause will be removed without penalty upon request.
PLEASE NOTE: Due to important legal limitations, the NCMS does not seek, and asks that you do not share, any specific information about your practice’s negotiated rates or the contractual terms that you have agreed to in your managed care contracts.
at 11:31 am
I would like NCMS to work toward a legislation mandating all Insurance companies to accept assignment of benefits and sending payments directly to MD/Providers, post their fee schedules online for employers/public and providers to view, follow (AMA/NCMS)fair contracting policy to ensure all providers are paid equally without discrimination, and set a minimum pay rate(set by insurance commissioner based on NC legislation) based on current market value and medicare RBRVS with automatic rate adjusments based on yearly inflation rate. This will help all MD/DO providers equally and give people a choice in their healthcare.
Why not BCBS and other insurance companies also pledge to reimburse equally to all physicians regardless of their affiliation with a large network or system?? where their insured are actually receiving a better quality care.
I would like for NCMS to do and publish a study comparing BCBS Physician reimbursement rates, BCBS executives salaries, BCBS premium rates and profits, Medicare reimbursement rates, cost of living & inflation rates over last 10-15 years to see where all those premium dollars are going???? and let the PUBLIC know..the truth.
at 9:48 pm
Should be med mal protection
at 9:47 pm
Let’s see, Dr. Cline. We”ve gotten where we are under 12 years of Dems (Clinton/Obama) and 8 years of Reps (Bush). Started w/ “managed care” in early 90’s under who?
Nothing going on now in Mr. Obama’s plan to control insurance companies don’t fall back on “Admin percentage”-very easy to manipulate-or for med map protection or incentives for physician to reduce spending on defensive medicine.
What do I see in Mr. Romney that clearly is not on Mr. Obama’s radar? A defined set of objectives, an understanding that he must engage, respect, and cooperate with “the other side” to achieve those objectives, and most importantly, a man who has functioned in business in the real world, saving or creating jobs, following a budget and understands that we must address the governmentally created deficits in the national debt, Medicare, and SS for us to return our country to a strong, stable position. We’ve seen 4 years of bad, failed policies-it’s time to see what a leader who wants to follow sound constitutional and economic principles can do.
at 5:08 pm
There will be lots more provider money disappearing
Into margins of “illness is a profit motive” companies
If Romney has his way. Blue Cross already has a
Billion in money not paid to providers. Guess what,
They want more. Raise premiums, pay less to doctos
And hospials and keep the rest!!! Wahooo!
TF Kline MD PhD