Legislators Press ABCBS on Fee Changes

In a public hearing on November 4, legislators on the Joint Interim Committee on Insurance & Commerce pressed representatives of ABCBS on their decision to reduce their current fee schedule by 15 percent for “non-primary care” specialties.  The reduced fee schedule applies to the new products being offered as “metallic” plans written for individual policies (i.e. not group policies) that comply with the ACA.  It does not apply to the current products that the carrier has in force today.  Legislators did not appear satisfied with the responses provided by the carrier and were very clear in stating their desire that the decision be reconsidered.  To date, AMS has received no indication from ABCBS that they intend to modify or rescind the decision.

The reduced rate has created two irrational sets of results. To the extent that primary care specialties (PC) and non-primary care specialties (NPC) provide the same service, the NPC physician will be paid 15 percent less.  As an example, a board certified Ob/Gyn will receive 15 percent less than a family physician to deliver a baby; an ophthalmologist will receive 15 percent less to remove a simple foreign body from the eye.  The same is true for office visits and other services provided by both PC and NPC physicians.  It also means that for some specialty services, ABCBS will be paying less than Medicaid currently pays for the same service.