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California Health Insurance Rescissions: Doctors Dissatisfied
By: John R. Graham
8.21.2009
Physicians struggle to get paid after health plans' rescind policies.
The long saga of "rescissions" of individual health policies in California shows no sign of ending. The California Medical Association and the Los Angeles County Medical Association have filed an amicus curiae brief in the case of Anthem Blue Cross, which settled allegations of illegal rescissions with the Department of Managed Health Care (DMHC) in return for contacting the rescinded policy-holders and allowing them to "voluntarily" re-enroll without underwriting and pay any out-of-pocket expenses that they had incurred. (My last post on a long trail of posts about the history of the California rescissions noted that Insurance Commissioner Poizner seems to have learned that some people actually do lie on their health-insurance applications.)
Organized medicine's beef with the settlement is that it does not guarantee that doctors be paid. If doctors treated patients whose policies were subsequently rescinded, they've been stuck with accounts receivable that they're unlikely to collect. So, they've joined asked the court to dump the settlement with DMHC and squeeze more cash from Blue Cross. Well, I've never read a PPO contract with Anthem Blue Cross, but I'm a little surprised that the doctors haven't negotiated that the health plan will pay any claims up to the date of rescission. Maybe this has to do with the imbalance of power between health plans and physicians, which I've previously addressed.
Nevertheless, a lawsuit certainly seems an unsatisfactory path to resolution. As I've written before in this thread, as long as doctors are dependent on insurers, instead of patients, for their incomes, they will be caught up in these unproductive struggles.
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