DOI Hearing Officer Rules in BCBSNC’s Favor on Radiology Double Billing Issue

CHAPEL HILL, N.C. – A Hearing Officer with the North Carolina Department of Insurance has ruled that BCBSNC may make reasonable changes to its reimbursement policies without renegotiating contracts with doctors and hospitals.  
 
“This decision is a win for our customers – who will save $16 million a year in wasteful charges – and it’s a win for North Carolina,” said BCBSNC CEO Brad Wilson. “This will protect consumers and our customers from unreasonable charges.”
 
The Hearing Officer’s ruling stated, in part, that requiring health insurers to renegotiate contracts in order to change reimbursement policies “would severely jeopardize the operation and function of health plan provider networks and would substantially increase the cost of health care.” In addressing the specific practice of providers billing more than one time for items and services only provided once, the hearing officer stated that ruling in favor of BCBSNC  “ensures that BCBSNC and consumers are not billed for services that are not provided.”
 
The decision follows a hearing on the complaint filed by the North Carolina Medical Society, the North Carolina Hospital Association, and the NC Chapter of the American College of Radiology, Inc. in October 2011 around BCBSNC’s efforts to change the reimbursement policy to prevent excessive charges for multiple radiology procedures performed in a single visit.
 
 
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 3.6 million members, including approximately 900,000 served on behalf of other Blue Plans. For 78 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 was named one of the World’s Most Ethical Companies by Ethisphere Institute in 2012. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com.
 
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