Cause for Concern with new BCBS of Georgia Provider Agreement

October 1, 2014

It appears that Blue Cross Blue Shield of Georgia may be changing the rules without giving participating physicians fair advance notice.

The Medical Association of Georgia (MAG) has posted an article on its website alerting physicians that a new Blue Cross Blue Shield of Georgia (BCBSGA) provider agreement will automatically go into effect on November 15, 2014, replacing your existing agreement(s).

There is currently no indication of contractual changes on the BCBSGA website.

Our clients in Georgia have requested samples of the new contract(s) and fee schedule(s) for review, but there has been no response as of the printing of this letter.

MAG is indicating there are several points of concern, as the new contract(s):

  • Does not require a signature to be effective, even if the physician/practice hasn’t received formal notification from BCBSGA;
  • Allows BCBSGA to recoup money for claims that were incorrectly submitted by the physician/practice, offsetting payments without notifying the physician/practice beforehand;
  • Allows BCBSGA to change its Procedure Manual by making a “good faith effort,” whereas a signature was required in the past;
  • Removes a physician’s right to participate in a class action lawsuit against BCBSGA;
  • Changes the clause on termination without cause, extending it to six months.

If you currently participate with BCBSGA, we encourage you to contact your BCBSGA representative and inquire if this new contract and fee schedule will apply to your practice.

If so, request full copies of both for review, and don’t hesitate to ask for more time to evaluate before it takes effect.

If you have questions, please feel free to contact Vachette Pathology at 866.407.0763.  To keep updated on this and other current issues for pathologists, see our latest news or connect with me on LinkedIn.

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