Rural Alabama Health Alliance Position Paper
 

Policy Limits Number of Eligible Providers
 

Blue Cross/Blue Shield has decided to limit the number of professional providers (MD’s) who will be eligible for reimbursement under BC/BS insurance coverage.  Blue Cross officials will select specialty physicians coming into the state or coming out of training to participate in the PMD program based on the company’s assessment of the need for their specialty based on the number of Blue Cross subscribers in that area.  According to Blue Cross officials these restrictions do not now apply to primary care physicians.
 

• Since BC/BS controls more than 80% of the commercial market in medical insurance in Alabama, not allowing a physician into their provider panel in essence keeps a doctor from being able to practice medicine in Alabama.

• This not only limits free enterprise, but it will affect the supply of physicians.  In some areas, particularly rural counties, this is a critical issue.

• Blue Cross/Blue Shield does a good job with their clients and delivers quality health care at affordable prices; we simply raise the issue of whether an insurance company should decide state health manpower issues.

A letter from the Medical Association of the State of Alabama (MASA) provides more information:
 

• Alabama does not have a state law that requires health plan networks to contract with “any  willing provider.”  Blue Cross is free to enter into contracts with only those physicians which it chooses to participate in their provider networks.

• In 1994 a law was passed in the Alabama Legislature which was sometimes incorrectly identified as an “any  willing provider” statute.  This law, Act 94-638, was actually a patient choice bill which provided, in effect, that a patient could choose to receive medicine services from a non-participating physician on the same basis that it reimburses participating physicians.  As you may know, this law has been tied up in court by Blue Cross since its passage in 1994.

• Both the Federal District Court and the Alabama Supreme Court have ruled that this law does not apply to Blue Cross/Blue Shield because the enabling legislation for Blue Cross/Blue Shield exempts the Company from most insurance regulations and this law did not amend or modify that exemption.  Blue Cross also claims that this law is pre-empted by the Federal ERISA law, at least to the extent that it would apply to employer sponsored self-funded health plans administered by Blue Cross/Blue Shield.