May 16, 2002 - Medical Association of Georgia (MAG)
Receives Favorable Ruling in Case Against Blue Cross and Blue Shield of Georgia
(BCBSGA)
A Fulton County court has issued a final judgment in favor
of Plaintiff Physicians in a lawsuit begun five years ago. The purpose of the
suit was to require BCBSGA to publish its fee schedules and methods of
calculating payments to Georgia physicians participating in BCBSGA plans. The
Order, issued by the Superior Court of Fulton County on April 29, 2002, orders
BCBSGA to provide fee schedules and methodology used for determining
compensation by May 29, 2002. The information provided must be in sufficient
detail to allow participating doctors to calculate whether they have been
appropriately compensated under the plans. “This is a major victory for Georgia
physicians and our patients,” says Alan L. Plummer, M.D., newly installed
President of the Medical Association of Georgia. “We are proud of the fact that
MAG has lead the fight to stop abuses by insurance companies. Eliminating these
abuses will have a positive impact on the patient-physician relationship and
enable us to provide the best health care possible to all our patients,” he
concluded. For additional information as well as a Press Release concerning the
ruling please go to The Medical Association of Georgia's website. A copy of the
court’s Order is also available here.
May 16,
2002---California’s Largest HMO Paid Clerks for Scheduling Less Appointments and
Limiting
Calls
The Los Angeles Times reported today that Kaiser
Permanente, the state’s largest health maintenance organization, paid clerks in
its call centers to limit time spent on phone calls with members as well as
bonuses for reducing the total number of doctors appointments scheduled. Kaiser
has responded that the bonus program is no longer in use and was an effort to
improve member service. A report commissioned by the health care provider and
obtained by the Times also noted concern expressed by registered nurses employed
by the company related to the delay in appointments. The over 500 responding
nurses indicated that unlicensed clerks are making evaluations related to
medical conditions, a situation that is being investigated by state HMO
regulators, according to the Times article. The extensive page one article
reported “one of Kaiser's own physicians found problems at the Vallejo call
center. Dr. Harvey Kayman, a doctor at the pediatric call center from December
1999 until April 2000, wrote in a report the month he left that the center
needed a ‘complete revision of the mission, goals and objectives ... so that it
no longer functions as a barrier, but an agent of communication.’ ” For the
complete article with quotes by additional concerned health care professionals
please go to The LA Times
website.
