Georgia Blues plan sued under any-willing-provider law

The health plan says the statute requiring open networks does not apply to HMOs.

By Amy Lynn Sorrel, AMNews staff. Feb. 18, 2008.

Georgia physicians are fighting what they say is an illegal attempt by the state Blues to shut some doctors out of the health plan's HMO network in violation of the state's so-called any-willing-provider law.

Most states have such laws, which generally prohibit managed care entities from excluding doctors from their panels as long as the physicians meet the plan's criteria and are willing to accept its terms. But doctors say BlueCross BlueShield of Georgia's refusal to include some of Northeast Georgia Cancer Care LLC's oncologists in its HMO plan is putting patient care at stake.

Northeast Georgia Cancer Care sued the Blues after the company told doctors its medical oncology network was closed while it gave an exclusive HMO contract to another cancer group for those services in the Athens, Ga., market. Both sides were renegotiating after settling a separate contract dispute, which remains confidential. The Blues maintained its HMO and PPO contracts with Northeast's radiology oncologists but allowed only the medical oncologists back into its PPO plan.

As a result, more than 100 of Northeast Georgia Cancer Care's patients lost their long-time doctors and now are forced to drive hours away for care, said oncologist Mark Vrana, MD, the group's managing physician.

"We can't take care of our patients the way we've been taking care of them for years," Dr. Vrana said. His practice has satellite clinics serving more than 30 northeast Georgia counties in the largely rural area, and he said he often travels more than 60 miles to treat patients who otherwise would have no access to care.