Blue Cross and Blue Shield of Texas Reaches Agreement with Texas Attorney General’s Office, Resolving Investigation of Physician-Related Business Practices
Richardson, TX — Blue Cross and Blue Shield of Texas (BCBSTX) reached an agreement with the Texas Attorney General's office which resolves its investigation related to BCBSTX's use of specific affordability indicators and the issue of physicians' rights to discuss all available treatment options with Blue Cross members.
"After listening to the concerns expressed by the Attorney General's office and other constituents, we signed an Assurance of Voluntary Compliance (AVC) last week," says Darren Rodgers, president, Blue Cross and Blue Shield of Texas. "We agreed to execute the AVC despite the fact that the matters addressed in the AVC are not things we do today because we voluntarily modified certain business practices related to provision of consumer information several months ago. Therefore, there is no impact to any of our current business practices as a result of this agreement. Our plans now include the introduction of a revised indicator to assist members in determining relevant cost information for highly utilized services later this year."
The second matter addressed in the agreement relates to the way BCBSTX communicates to participating network physicians regarding their agreement to refer Blue Cross members to other network providers. BCBSTX recognizes that employers and consumers who purchase network-based products count on health plans to limit their exposure to unregulated costs from out-of-network providers.
"We consider network physicians offering referrals to other network providers to be one of the important commitments providers accept when they agree to participate in health care networks, as this practice can be helpful to consumers struggling to afford the spiraling cost of care," says Rodgers. "Blue Cross and Blue Shield of Texas has now changed its communications with participating physicians to more clearly state that we believe physicians have the right to discuss all available treatment options."
Blue Cross and Blue Shield of Texas — the only statewide, customer-owned health insurer in Texas — is the largest provider of health benefits in the state, working with nearly 40,000 physicians and 400 hospitals to serve 4 million members in all 254 counties. Blue Cross and Blue Shield of Texas is a Division of Health Care Service Corporation (HCSC), the country's largest customer-owned health insurer and fourth largest health insurer overall. HCSC is a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.
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