Kentucky measure calls for clearer contracts for doctors, plans

New rules expanding insurer regulation would also speed up the credentialing process.

By Emily Berry, AMNews staff. May 12, 2008.

Kentucky has passed legislation mandating clearer and more balanced contracting between health plans and physicians. The laws are about as broad as those just passed by neighboring Ohio.

The Kentucky legislation requires health plans to expedite credentialing, give physicians a fee schedule and notice of changes in terms. The legislation passed in April with broad support in both the Kentucky Senate and House. Gov. Steve Beshear is expected to sign the bill into law.

Bills regulating contracts between doctors and health plans are still pending in other states, including Connecticut, New Jersey and New York.

"I think the issues are similar everywhere," said Kentucky Medical Assn. President Thomas Slabaugh Sr., MD, a urologist in Lexington. "If you're [addressing them] on a state-by-state basis, it's a lot of work, but unfortunately I think that's the way it has to be done."

Slow credentialing and, more specifically, withholding payment until credentialing is complete have been major problems for new physicians in Kentucky as elsewhere, Dr. Slabaugh said. Under the new law credentialing would have to be completed within 90 days.

"Physicians everywhere are having problems with insurance companies -- we call them nuisance issues," Dr. Slabaugh said.

The bill on the governor's desk can help both physicians and health plans, said Christi Lanier-Robinson, spokeswoman for Anthem Blue Cross and Blue Shield of Kentucky.

"It allows the proponents to meet their goals while also allowing us to protect the needs of our members and maintain our level of service," Lanier-Robinson said. "We feel like it's a win-win situation."