CHAPEL HILL, N.C. –Blue Cross and Blue Shield of North Carolina (BCBSNC) and the North Carolina Medical Society announced today they have joined with other Blues companies and State Medical Societies across the country in reaching a settlement in a national class-action lawsuit. The settlement resolves a number of past issues between physicians and Blues companies regarding claims processing and payment, utilization management, physician contracts and other matters.
“We are pleased to move beyond past disputes,” said Dr. Don Bradley, BCBSNC senior vice president and chief medical officer. “Continued litigation of this case would have been lengthy, burdensome and expensive. We think it is more important to invest in improvements to the way we do business and in relationships with our doctors.”
“As physicians, our first priority to our patients is to provide high quality care. We believe the commitments obtained from BCBSNC in this settlement will enable physicians to offer the best possible care and will open the door for further deliberations on key health policy issues,” said Dr. Darlyne Menscer, president of the North Carolina Medical Society and a family physician from Charlotte.
The new agreement requires BCBSNC to enhance claims processing and payment procedures and to streamline administrative requirements for physician practices. The goal is to provide savings to physicians in overhead costs and time spent submitting claims and reviewing payment. In addition, the agreement provides mechanisms to address compliance disputes or possible violations.
“As always, we’re committed to making it easier for providers to work with us,” said Dr. Bradley. “I believe this settlement will strengthen our relationships with participating physicians. We greatly value our network of physicians, and we are pleased to put these issues behind us.”
BCBSNC and the North Carolina Medical Society have also agreed to meet in the near future to continue to discuss issues of mutual interest. As stated in the settlement agreement, the meeting “will include but not be limited to good faith discussions on coordination of benefits; any outstanding issues regarding immunizations and administration; physician contracts; nonparticipating physician issues; and medical necessity appeals.”
BCBSNC will pay approximately $6.2 million or 4.8 percent of the cash portion of the settlement to a fund created by the settling Blue Plans from which physicians may seek compensation or select a charitable organization to receive their payment. In addition, BCBSNC will pay legal fees determined by the court, not to exceed $2.39 million.
About the North Carolina Medical Society:
The North Carolina Medical Society is the largest and oldest professional member organization in North Carolina, representing approximately 11,500 physicians and physician assistants who practice in the state. Founded in 1849, the Medical Society seeks to promote access to quality health care for all citizens in North Carolina and champions initiatives that seek to improve quality of care and promote patient safety.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.4 million members, including approximately 749,000 served on behalf of other Blue Plans. For 73 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at bcbsnc.com.