Georgia Blues must open fee schedule

Latest court action declares physicians victorious.

By Julie A. Jacob, AMNews staff. May 27, 2002.

The Medical Assn. of Georgia has won its lawsuit against Blue Cross and Blue Shield of Georgia, in which the medical society sought to require the insurer to disclose its physician fee schedule.

The Superior Court of Fulton County issued a final judgment on the lawsuit April 29, ordering the Georgia Blues by May 29 to publish its physician fee schedule and method of calculating payments to physicians participating in its health plans.

The AMA, whose Litigation Center and Private Sector Advocacy group helped the Georgia association with legal strategy and financing of the lawsuit, said this was the first case it knew of in which a health plan had been forced to reveal in advance how much it would pay physicians for their services.

The Georgia Blues, a division of Thousand Oaks, Calif.-based WellPoint Health Systems, had no comment on the case.

MAG filed a lawsuit against the Georgia Blues in 1997 over the insurer's refusal to provide participating physicians with its fee schedule and method of calculating payments to physicians. A trial court ruled in favor of the Georgia Blues, but in January 2001 the Georgia Court of Appeals reversed the trial court's decision and ruled that physicians had a right to know the fee schedule and how the insurer was calculating its payments to physicians. [...]