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)

But if a year from now specialists find the reimbursements are a drain on their income, they will think twice about sticking with ABCBS, Magie said.

The Baby-Delivery Example

David Wroten, the executive vice president of the Arkansas Medical Society, told Arkansas Business that he thinks ABCBS’ plan is the wrong approach to reducing health care costs.

“We certainly need to support primary care in this state, … but it’s a little difficult to support reducing reimbursements for one group so you can support another,” he said.

The problem is highlighted in the delivery of babies, he said. Medicaid pays for about two-thirds of all the births in Arkansas, Wroten said. But under health care reform, most of the expectant mothers currently on Medicaid in Arkansas will be shifted to “private option” plans, which is Arkansas’ strategy of using federal dollars to buy private insurance on the exchange for the working poor rather than expanding the traditional Medicaid program.

Not all family doctors deliver babies, but a number of them in the rural areas do, Wroten said. And under ABCBS’s fee structure, an OB-GYN would be paid 15 percent less for delivering the same baby, Wroten said.

“We think more thought should have been put into that,” he said.

Wroten said he wished ABCBS officials had talked with the Medical Society about ways to lower health care costs.

Wroten said he doesn’t think there’s anything the Medical Society can do about the rates for ABCBS at this point, though. “We can’t dictate what their reimbursement is,” Wroten said. “We just have to hope at some point that Blue Cross Blue Shield changes its mind.”

Max Greenwood, a spokeswoman for ABCBS, told said last week that she didn’t understand the Medical Society’s concerns.

“We established a reimbursement schedule where providers are going to get paid a lot more than they would have been paid under traditional Medicaid,” she said. “So to us it’s merely a fee schedule for a new line of business.”

She said ABCBS doesn’t have any intention of changing its reimbursement structure at this point. “We thought this was a good approach for this start of this new product,” Greenwood said.



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