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| The Pennsylvania Medical Society (PMS) has taken actions against unilateral Independence Blue Cross (IBC) fee schedule adjustments. | In response to IBC’s Sept. 30 announcement to re-adjust its previous
HMO and PPO reimbursement cuts to surgeons and other specialists, the PMS has:
(Pennsylvania Medical Society, December 14, 1998) |
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| Independence Blue Cross (IBC) will make retroactive upward adjustments to surgical reimbursements in response to physician protest of cuts that went into effect July 1. | In a letter to a Philadelphia-area orthopedic surgeons obtained by Physician's News Digest, IBC states that they are preparing to implement "upward adjustments" to the fees for a number of orthopedic procedures in light of some inequities that may have been created for orthopedists by the July 1 cuts and that they are withdrawing the contingency notice of termination outlined in their July 2 letter. Other area orthopedists and urologists have received similar letters. Jack Seddon, executive director of the Federation of Physicians and Dentists (FPD), said that surgeons who have already rejected IBC’s new rates will have to be returned to the old rates or terminated, notwithstanding what IBCs latest upward adjustments are. Seddon claims that approximately 350 area surgeons have joined the FPD to negotiate on their behalf with IBC. (Physician's News Digest, August 10, 1998) | |
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| Independence Blue Cross (IBC) reimbursement rate cuts extend to common primary care services. | Pediatricians, internists and other primary care physicians in the Philadelphia area said that IBC’s new payment rates for its Personal Choice program decrease reimbursement for 80 percent of their medical services, including routine office visits, reported the Inquirer. IBC conceded that it decreased payments for some types of office visits and said that it may make changes pending a continuing evaluation of the fee schedules, the Inquirer added. (Philadelphia Inquirer, August 13, 1998) | |
| The U.S. Department of Justice filed an antitrust complaint against the Federation of Physicians and Dentists (FPD). | The complaint alleges that the FPD organized orthopedic surgeons in Delaware to illegally boycott Blue Cross & Blue Shield of Delaware. The complaint charges that the FPD misused a "third party messenger" arrangement to facilitate illegal collusion by doctors to maintain high fee levels. The "third party messenger" model was developed by the Federal Trade Commission for use by independent contractor physicians in negotiations with health insurers. "A ‘messenger’ arrangement, when used with adequate safeguards, may aid in the transmission of information between health insurance plans and doctors and speed the negotiation process," said a Justice Department release. Over 350 physicians in southeastern Pennsylvania have joined the FPD in order to utilize them as a messenger with Independence Blue Cross. (U.S. Department of Justice, August 12, 1998; Physician’s News Digest, August 13, 1998) | |
