SPECIFIC PAYER ITEMS
Blue Cross/Blue Shield

Error in Holding Physicians Responsible for Out of Network Services

Scores of physicians in the NYC metropolitan area participating with Empire BC/BS received a notice in error from Empire indicating that would be held personally financially responsible if they “allowed” their patients to access out of network services. MSSNY immediately filed complaints regarding this outrageous provision with the New York State Department of Health (DOH) and State Insurance Department (SID). DOH officials confirmed that the objectionable amendment had not been approved by DOH and should not have been sent to physicians in the first instance.

Empire has sent a corrective notice to physicians which deleted the terminology that physicians would be held “financially responsible”. However, the corrective notice still provides that physicians are “responsible for ensuring” that their Empire-enrolled patients receive covered health care services from in-network providers. MSSNY has raised concerns that this terminology does not completely fix the problem, as it still could pin financial responsibility on physicians whose patients’ access out of network services. Empire’s legal counsel has insisted to MSSNY that the provision is not intended to impose financial responsibility on such physicians. MSSNY is asking the DOH to require Empire to send another notice to its participating physicians clarifying this provision. Empire had told physicians that they must agree to the new rules within 30 days or drop out of Empire.”