BCBSNC has sent out contract addenda to many physician practices in order to comply with Senate Bill 877 Fair Contracting. Senate Bill 877 was a major legislative priority of North Carolina physicians and medical group managers in the 2009 session. The NCMS worked diligently as part of a coalition to make progress in this area for its members. We will continue to work with our coalition partners to ensure that the intent of S877 is carried out by all payers. NCMS is reviewing the BCBSNC addenda and has concerns related to the contact notice provision, pricing policy disclosure, availability of new fees and other provisions. We will provide practices with more information as soon as the analysis is complete. Please comment on the addenda below or email any feedback to [email protected].
at 11:48 am
Here we go again!!! A major profit making insurance company wants to show us its mighty power. One sided contract language should be unacceptable to all of us. JUST DON’T SIGN IT.
Inform all patients, see them as an out of network patients, keep patients credit card on file and charge at the time of service, give 20-30% discounts to all and file insurance claims for them for free. May be now it’s time federal government takes over so called not-for-profit BCBS and make it a “public option” health plan.
I believe, this is a right time for us to have standard contracts and fees, and make all insurance companies comply with anti-trust laws,pay 5% of gross revenue as a fees to do business,limit profit to 10% and fix executes salaries to less than 1 million.
at 3:30 pm
BCBS-NC’s standard contract provisions only allows it to make unilateral amendments (without the other party’s mutual consent) if a law changes. That provision does not allow BCBS-NC to expand upon or interpret the laws. It does not allow BCBS-NC to piggy-back new conditions that are not regulatory requirements into a contract using such an tactic. Why did the NC Department of Insurance (the agency resposnible for previewing these types of “standard” documents) allow a document that is such a flagarent departure from the legislation to be issued?
at 1:39 pm
I felt the BCBSNC Addemdum was one sideded at best, especially 4.2. When did questioning reimbursement of a contract mean automatic termination ??? I always throught contract negotiations were to be between both parties not just one. I am glad the NC Medical Society is on top of this.
at 11:11 am
Providers can and should be able to object to a change, but should that objection automatically be construed as a complete termination of your contract?
Unless you are ready to terminate, you can’t really object to anything. The cover letter is misleading because it states something different than what’s in the actual amendment and the legislation.
at 10:29 pm
Carol,
Maybe I am missing something but it seems to make sense to me that providers can/should object to the addendum to not comply; of course, the issue here is getting the word out for our colleagues to decide what to do.
CG
at 11:23 am
It appears to me that Section 4.2 of the BCBSNC addendum is inconsistent with Section 58-50-272 (c) of Senate Bill 877. the Bill states that “If a health care provider objects to a proposed amendment, then the proposed amendment is not effective and the initiating health benefit plan or insurer shall be entitled to terminate the contract upon 60 days written notice to the health care provider”. Although BCBSNC’s cover letter states (4th paragraph) “If you do not object to the proposed change, the change goes into effect 60 days from the date of receipt of the notice. If you do object, the change will not become effective; however BCBSNC reserves the right to terminate your contract pursuant to the enclosed addendum”, the actual addendum is somwhat different….”If you object to the proposed change, such objection shall consitute your notice of termination to us of your Agreement” The onus of termination is put on the provider rather than on BCBSNC.