An advisory arm of California Pacific Medical Center has warned the hospital's medical group about the handling of patients enrolled in Blue Cross of California's Prudent Buyer PPO, claiming the insurer's policies create a financial conflict of interest.
California Pacific Medical Associates has sent a letter to the San Francisco hospital system's 700-member medical group, criticizing a Blue Cross policy of cutting reimbursement if providers make referrals to out-of-network specialists without approval from the health plan.
Prudent Buyer has 2 million enrollees and a physician network of more than 10,000.
Signed by W. Gordon Peacock, M.D., California Pacific Medical Associates' chairman, and approved unanimously by its board of directors, the letter urged physicians to exercise caution when signing a contract with Blue Cross. It also discussed available options, including not contracting with the Prudent Buyer plan, not accepting new patients enrolled in the PPO or even terminating existing contracts.
"We want to pressure Blue Cross to present better contracts to our doctor members. They're advertising a PPO contract but are pressuring doctors to sign contracts consistent with HMO language," Peacock said. "It's a restriction of choice for the patient and could disrupt continuity of care."
Peacock added that Blue Cross' policy could entangle referring physicians in litigation should the patient sue the specialist for malpractice, because the policy might be presumed to cloud a referring physician's judgment.
Another concern raised by Peacock's organization was a policy requiring physicians to notify Blue Cross if they treat any patient in the first trimester of pregnancy. Peacock said that violates the confidentiality of the physician/patient relationship.
Officials with Blue Cross, based in Woodland Hills, confirmed the health plan has a policy regarding prior notice for out-of-network referrals and that reimbursements to referring physicians could be cut as much 36%. However, Blue Cross spokeswoman Elise Anderson said the policy has been in effect since 1994.
"We don't know why it's causing a stir now," said Anderson, who added that she is unaware of any instances where reduced reimbursements have occurred.
Anderson could not immediately confirm the pregnancy notification policy, but she questioned why California Pacific Medical Associates linked it to the referral issue.