Alabama Doctors File Complaints Against State Blues Plan

The 2007 settlement of the case, Love et al. v. Blue Cross and Blue Shield Assn. et al., was finalized when the last appeal was rejected in June, though some provisions took effect before then.

The settlement over payment practices involved the BlueCross BlueShield Assn. and 30 affiliated plans, including Alabama. In July, $131 million of settlement claims were mailed to physicians who had filed claims by Oct. 19, 2007. The Love case was one of a series of lawsuits filed by physicians against health plans that were settled in U.S. District Court in Miami. None of the plans admitted wrongdoing.

What the physicians say

In their compliance dispute filings, physicians claim the Alabama Blues:

• Failed to give doctors sufficient notice of substantial changes it had planned for its fee schedule in the coming months. The company initially planned to roll out new payment rates and rules starting Dec. 1. (The company announced Nov. 3 that it would delay implementing changes until no later than July 2010.)
• Never formed a specialty physicians' advisory committee required by the settlement agreement.
• Has not paid for claims that included Current Procedural Terminology modifiers 25 and 59.

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