Insurance company holding provider hostage


(Lynn Ho) #1

I am on track ( I think) to transition my existing practice to direct care practice Jan 1 2019
Running into an obstacle with my local BCBSRI:
When I called their provider service center in October 2018, they told me it would take a month to de-enroll from their network. However in November- December I received a series of emails from BCBSRI stating that my Nov 1 2018 filing date would only allow me to disenroll from their network by Jan 1 2020 ! They stated they sent an amendment to my contract in May for 2017 requiring this bizarrely long unenrollment period (which I dont recall but they may have); the latest time I could have unenrolled for Jan 2019 was June 2018. Has any heard of this type of insurer control over providers before and if you have any suggestions as to what to do, I will gladly hear them
thanks - Lynn


(Karl N. Hanson, MD) #2

Lynn,
Ask to see the amendment out of curiosity. That seems like impeding commerce. I would not take their word for it.
If it were me and the amendment actually exists, I would ignore it and plod ahead. Industry standard is 60 - 90 days so just give notice and roll.
Karl


(Lynn Ho) #3

This is what they sent:
I did indeed send in notice of termination Nov 1 but it could get ugly if they chose to make a point of reinforcing their contract .
The worse thing that could happen is 1 ) they could sue me for breach of contract or 2) they could refuse to honor prescriptions, orders, tests for my patients still insured by them .
Wondering if I should consult a health care lawyer.
There’s always something!

Hi Dr. Ho,

I just wanted to touch base with you to confirm the following. I know that you mentioned that there was some misinformation provided to you by the Provider Service center, where they stated that you could terminate your contract with BCBSRI with a 30 day notice. I have confirmed the following, per the contract reinstatements that were implemented in 2017.

VI. TERM AND TERMINATION

A. This Agreement shall commence on the day after the execution of the Agreement by the parties hereto and approval by Blue Cross’ Credentialing Committee of successful completion of credentialing of the Physician by Blue Cross hereof and shall continue thereafter until December 31st of the same year, unless this Agreement is earlier terminated as set forth in this Section VI. Thereafter, this Agreement shall automatically be extended for consecutive additional terms of twelve (12) months each, unless either party provides the other party with written notice of its intention not to extend the term at least one hundred eighty (180) days prior to the end of the initial term or any subsequent term.

Since BCBSRI was notified of your wish to non-renew your Agreement after 180 days before the end of the year, your non-renewal would be effective 1/1 of the following year. In this case because the non-renewal was received in November of this year (2018), your non-renewal would be effective 1/1/2020.


(Jennifer Allen) #4

How is that even enforceable? Quit your job, open a new one that doesn’t take insurance. What can they do about it?


(John Bender) #5

Lynn,

We did not disenroll with BCBS, we stayed in-network as providers and simply stopped filing claims 3 years ago. Since no claims are being filed out of our office, the patients are not being balance-billed, in fact they are not being billed fee for service at all. But when I order their MRI, etc, it is still covered under BCBS, since I am a network provider. The patients are paying their subscriptions for direct care.

After three years, no payer (CIGNA, Humana, Aetna, United Health Group, Anthem/BCBS) has complained.

-John