NASHVILLE, Tenn., Nov. 7 HealthLeaders-InterStudy, theleading provider of managed care market intelligence, reports that Rochesterphysicians will likely continue rallying against local insurance giantExcellus BlueCross BlueShield, in an attempt to thwart its power in the localmarketplace. According to the latest Rochester Market Overview, a new policyon imaging services and the insurer's move to individual physician contractshas the local physician community on edge.
"Excellus BlueCross BlueShield is the dominant insurer in the Rochestermarket," states Renee Burnham, market analyst for HealthLeaders-InterStudy andauthor of the report. "New policies and contracting methods are changing thestructure of the provider market, especially as physicians seek to hold theirground on reimbursement."
Prior to 2007, Rochester physicians largely relied on contractnegotiations conducted by three major independent physicians associations(IPAs) for reimbursement rates. However, effective Jan. 1, 2007, the payorgiant terminated contracts with these IPAs, electing instead to contract withphysicians individually. After some physician protest, most local providersended up signing new contracts with the health plan.
Local physicians are also displeased with a new Excellus policy thatrequires them to obtain approval for imaging services. Excellus has a contractwith Wappingers Falls, N.Y.-based CareCore National to manage memberutilization of diagnostic imaging services. Under the plan that went intoeffect on Oct. 8, 2007, a physician is required to fill out a three-page formand submit it for approval, which can take up to two days in a non-urgentcase.
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