It's difficult to terminate a doctor's contract, Smethers said. Many threaten to sue if they are dropped. Smethers said the rules are being tightened and it is not as easy for a doctor to get onto a plan. Like other health insurers, Blue Cross updates credentials on its doctors every two years. Doctors have to submit their medical board records and report any malpractice cases and hospital disciplines.
Doctors also have a chance to explain problems in their records.
Smethers estimates that Blue Cross drops a dozen to two dozen doctors annually through this process. Most insurers surveyed said they look through medical board minutes to see whether any serious actions have been taken against their doctors. For most, however, an advisory letter doesn't raise red flags. The advisory letter just means that the doctor and the board had a difference of opinion about medical care, said Dr. Richard Jacobs, vice president of medical affairs for Maricopa Integrated Health System, which oversees Maricopa Medical Center, the county's hospital, as well as clinics and health care plans. If a doctor gets a serious discipline from the medical board, Jacobs' group reviews the case immediately.