Regence BlueShield, Physician Leaders Agree That Revised Contract Responds To Provider Concerns
SEATTLE, Dec. 15 /PRNewswire/ -- Regence BlueShield and the Washington State Medical Association, following several months of collaborative review and revisions, have agreed that a contract first offered to more than 15,000 physicians and other health care providers last summer now contains significant improvements that benefit both providers and patients. The Washington State Medical Association got involved in September when many physicians voiced their objections to the new Regence BlueShield contract. In addition, the Office of the Insurance Commissioner has finished reviewing the revised contract and has concluded that the agreement is in compliance with state law. "The physician community is at the heart of what we do as a health plan," said Rich Nelson, president and chief executive officer of Regence BlueShield. "Our ability to work collaboratively with doctors is critical. Our initial process for creating this new contract did not involve the physician community. Throughout the last three months, we have worked diligently with the Washington State Medical Association and other community providers on changes to this contract. This is a positive step toward forging more collaborative working relationships with our practitioners." "Regence BlueShield has responded seriously to our concerns," said Dr. Mark Adams, President of the Washington State Medical Association. "The new contract is a definite improvement." The Washington State Coalition of Mental Health Professionals and Consumers and the Washington State Society for Clinical Social Work consider the agreement a significant improvement and agree that it "should be put to providers for their consideration," according to Laura Groshong, BCD, a clinical social worker who represents both organizations. "We have a much better working relationship with Regence BlueShield today, and we plan to work together in the future," she said. The biggest problem physicians had with the Regence BlueShield contract focused on medical necessity. The medical association and other providers said the initial contract appeared to put the health insurer in the position of determining what is medically necessary for a patient. Regence BlueShield maintained that was never the case, but the health plan did make significant efforts to change the contract language, making it clearer to physicians and other providers that the doctor is always solely responsible for making medical decisions on behalf of a patient. "Physicians are the patient's advocate and we believe this contract enables doctors to put their patients first," said Dr. Donald Storey, Regence BlueShield Medical Director. "We've worked hard to ensure that this contract reflects the concerns our physicians voiced to us on medical necessity and many other issues. We've worked closely with the Washington State Medical Association and other providers to hear their concerns and reflect their input in this new contract." The revised Regence BlueShield contracts will be distributed to providers beginning in January 1999. All providers have continued to be covered under their previous contracts -- no interruption occurred while the revisions to the new contract were being made. "This is all very good news for health care consumers -- the state's leading health plan and the state's leading physician organization have worked collaboratively on an issue critical to all of us," said Nelson. "And we intend to continue to work collaboratively with our provider community on a wide range of issues. While we won't always agree on everything, it is essential that we begin building the trust needed to come together and resolve the many tough issues facing health care today." Regence BlueShield is the leading health plan in Washington state and provides health care coverage to more than 1.1 million subscribers in 16 Washington counties. The company has about $1.4 billion in revenues. Regence BlueShield is a non-profit health plan, one of 55 independent licensees of the national Blue Cross and Blue Shield Association. It is also an affiliate of The Regence Group, an alliance of Northwest health plans which includes: Regence BlueCross BlueShield of Oregon, Regence BlueShield of Idaho and Regence BlueCross BlueShield of Utah. CONTACT: Chris Bruzzo of Regence BlueShield, 206-389-7955
SOURCE Regence BlueShield
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