Georgia Insurance Commissioner Rules BCBS HMO Must Admit Physician Group

Citing the state’s “any-willing-provider” law, Georgia’s Insurance Commissioner John Oxendine ruled that Blue Cross Blue Shield Healthcare Plan of Georgia must allow Northeast Georgia Cancer Care of Athens into its HMO plan, according to a report in American Medical News.

Advertisement

The “any-willing-provider” law, in Georgia as in other states, says that physicians and healthcare providers that are in good standing with the state and licensed to practice have the right to join a network, according to the report. However, Georgia’s law does not require HMOs to accept any physician that wants to join. The recent decision is the first time a state commissioner has interpreted the law to mean just that.

Mr. Oxendine defended his decision saying that more physicians in a network means more choices for consumers, according to the report. The decision does not necessarily extend to all HMOs in the state, but Mr. Oxendine indicated he may extend the right in the future. The decision is expected to make a big impact due to the prominence of the insurer.

BCBS Healthcare Plan of Georgia has until the first week of May to appeal the ruling, according to the report. The company said in a statement that Mr. Oxendine’s decision does not represent the “language of the statute or the intent of the General Assembly.”

Northeast Georgia Cancer Care sued in June 2007 in response to a contract dispute that prohibited the practice to participate in BCBS’s HMO, although it continued to participate in its PPO. The Athens-Clarke County Superior Court granted the insurer’s motion to dismiss, which led to the practice’s filing with the insurance commission in 2009, according to the report.

Read the AMNews’s report about Georgia’s “any-willing-provider” law.

Advertisement

Next Up in Uncategorized

  • Nashville, Tenn.-based HCA Healthcare, the largest health system in the country, is seeking finance chiefs at six of its hospitals. …

Advertisement

Comments are closed.