Arkansas Blue Cross & Blue Shield's Reimbursement Rates Raise Concerns From Specialists

by Mark Friedman  on Monday, Dec. 16, 2013 12:00 am  

Arkansas Blue Cross & Blue Shield said the lower reimbursements to specialists encourage the use of family practice doctors. (Photo by Michael Pirnique)

Sen. Missy Irvin, R-Mountain View, fears Arkansas Blue Cross & Blue Shield’s new reimbursement payments to specialists will hurt health care in Arkansas.

Starting Jan. 1, ABCBS will pay physician specialists 15 percent less for the same procedures done by non-specialists, such as family practice doctors, for patients who bought policies through the new health insurance exchange, she said. The new fees won’t apply to the carrier’s current commercial policies or group plans.

Irvin told Arkansas Business last week that she predicts specialists won’t want to treat patients who have insurance purchased through the exchange or the physicians won’t practice in Arkansas because of the low rates.

“I think whether you’re poor, you’re on Medicaid, … it shouldn’t matter,” she said. “You should still be seen by a qualified physician,” said Irvin, who was one of a number of legislators who criticized the insurance carrier for the lower payments during an Joint Insurance & Commerce Committee hearing on Nov. 4.

Cal Kellogg, executive vice president and chief strategy officer for ABCBS, told legislators during the meeting that reducing pay to specialists was necessary to offer the lowest possible premium prices on the exchange.

“The only way that you can really, in the long term, look at having lower premiums is to start addressing the overall costs,” he told the committee, according to an audio recording made available to Arkansas Business. “And cost is driven by the prices that you pay someone and the quantity that they use the services.”

He also said that the specialists will end up receiving more money as a result of health care reform because more people will have health insurance.

“What we’ve done is we have now made available dollars for people who were having to treat folks either as charity care or they were having to do a significant amount of collections,” Kellogg said.

In addition, Kellogg said the lower reimbursements to specialists are designed to encourage people to use family practice doctors, an effort that’s being pushed under health care reform.

State Rep. Stephen Magie, D-Conway, an ophthalmologist, told Arkansas Business last week that he would have preferred for ABCBS to cut physicians’ fees across the board.

“It pits doctors against doctors in terms of their reimbursements,” Magie said. “It does not appear to be a fair way to reimburse physicians.”

Still, Magie said specialists aren’t planning to leave the ABCBS network over the fees. “I think most people will just accept it,” he said.



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