Update on BCBSNC Contract Addendum

As many of our readers will recall, NCMS worked during the 2009 session of the NC General Assembly to pass legislation requiring health plans to provide proper notice to physicians before they make changes to fee schedules (i.e., Senate Bill 877). On October 1, 2009, before the provisions of SB877 became effective, BCBSNC sent to its participating providers a contract addendum that we believe was inconsistent with the intent of SB877.

On October 26, 2009, NCMS, as part of a coalition of physician organizations, sent a letter to the Insurance Commissioner outlining major problems with the BCBSNC contract addendum. BCBSNC subsequently filed a revised addendum with the Insurance Commissioner in an effort to address some of these concerns. While the revised addendum contained a few improvements, it still fell short of the requirements of SB877. On December 18th, NCMS sent a second letter to the Insurance Commissioner outlining concerns with the revised addendum. Insurance Commissioner Wayne Goodwin subsequently denied approval of the BCBSNC revised addendum.

The settlement agreement that resolved the class action against Blue Plans and a number of state medical associations (including NCMS) contains provisions that require BCBSNC to comply with state law. Based in part on our belief that the addendum distributed by BCBSNC on October 1, 2009 is inconsistent with SB877, the NCMS has filed a compliance dispute under the settlement agreement.  The compliance dispute  alleges timeframe violations of notice requirements, overreaching exceptions to notice requirements for fee schedule changes, failure to conform to relevant provisions of the settlement agreement, and failure to follow state law.  We will keep our members apprised of developments in this area.


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1 Comment

  • These are complex issues that practicing physicians don’t have the time or knowledge to track. With our staff of experienced lawyers and managers, the NCMS can be a strong force to keep the insurers from trampling the rights of physicians and patients.
    Thanks for all you do.
    Every physician in NC benefits from this work; all should be members of NCMS
    chuck Willson