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Published: 2012-11-19 16:22:12
Updated: 2012-11-19 16:22:12

DOI reversal could save Blue Cross members $16M


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The North Carolina Department of Insurance has reversed itself on whether insurers can change the way they reimburse hospitals and physicians for radiology services without renegotiating contracts.

Blue Cross Blue Shield of North Carolina said the move could save policyholders $16 million a year, including $5 million for the State Health Plan.

The state's largest insurer, Blue Cross last year tried to implement new reimbursement policies to cut the amount hospitals and physicians receive for the "technical component" of scans – everything from checking a patient in to handing him or her a gown – when several scans are performed at once. Blue Cross and fellow insurer Aetna said they were being billed multiple times for such services, which were provided only once.

When hospitals and physicians balked at the change, the DOI issued a preliminary ruling last December that insurance companies needed to comply with state law requiring them to negotiate a new contract for changes in their fee schedule.

After a hearing on the matter, however, DOI ruled last week that limiting the amount paid for the technical component wasn't a change to the fee schedule, allowing insurers to begin issuing the lower reimbursements.


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Latest Comments
devilpride2012...I did a quote online. There must be something else here.

Yeah, their initial quote they give you online is a far cry from the actual rate you receive once you go through the underwriting process with them. I was initially quoted $118/month (Im a healthy 34 year old woman) but by the time they were done with me it was $230/month. My boss and his spouse was initially quoted $500+ this bumped up to almost $900 after the underwriters.

I had BCBS Advantage for a couple years ( self-employed) and my premium was 248$ a month, 5K deductible. You CAN get a low rate but a high deductible. It can be done. If I wanted a lower deductible, it would have ( logically)( been quite a bit more expensive. Luckily my husband works at a great company and we have great insurance with Cigna, at 99 @ month for two people. Bazinga.

$1200 a month?

This has to be with a low deductible....The higher your deductible, the lower your premium.

Their response? $1200/month.....

This is certainly not true..if indeed you are healthy and you are not on medication the cost range from $78.38 to $323.28 depending on what ded you want. I did a quote online. There must be something else here.

"I have BCBS and I am very happy with it. It is a low premium, they pay for well care, and any charges I have are charged at the negotiated rates and those are fine... whatelseisnew"

I think in looking at the rest of the comments on here, you realize that that this statement is a crock UNLESS as others have said, you get BCBS through your employer. I had BCBS through my employer for 14+ years and when I was unemployed, I inquired in BCBS about the cost for a individual/personal plan. Late 30's, 6'4", 200 lbs and no health issues. Their response? $1200/month. I went with another insurance company for $125/month.

Another thing "whatelseisnew," I would have thought that after the shellacking you and your brethren took on November 6th, you would have learned the lesson that fear mongering and scare tactics don't work.

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