A fight seen elsewhere Legal rulings in other parts of the country related to the publishing of physician payment information have been mixed. Recently, a Georgia appeals panel held that Blue Cross and Blue Shield of Georgia has to tell physicians and providers its reimbursement rates and methodology for calculating those rates. The court remanded the case to a trial court to determine how the decision will be carried out. That followed a Kentucky Supreme Court ruling against the attorney general who had interpreted Kentucky state law to mean the state had a right to disburse the fee schedules that health plans submitted for review. The Capital District plan is eager to resolve the matter, although not by giving doctors the payment information, said spokeswoman Mary Bray.
Physicians represent a majority on our board of directors.
It really is an issue in part of the contracting. The state law says fee schedules must be disclosed when contractual negotiations are being completed, so they know what the agreement is. Such deals allow for fees for the same procedure to vary from payment to payment, with the doctor having no understanding of how the fee was determined, doctors said. The plan claims that to make such disclosures would violate antitrust laws, Moy said. The state has yet to ask for similar information from other plans.