Will Georgia’s “Any Willing Provider” law apply to Blue Cross Blue Shield of Georgia’s HMOs?

Author: Medicoverage Staff

The Georgia Commissioner of Insurance is meeting today to determine whether Georgia’s “Any Willing Provider” law applies to HMOs.

Background into the Any Willing Provider law

In 2007, Northeast Georgia Cancer Care, LLC (NEGCC) decided to end its HMO provider contract with Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (BCBSHP) after a reimbursement dispute.  NEGCC subsequently requested a significant increase in its reimbursement rates.  As a result of NEGCC’s abrupt contract termination, BCBSHP negotiated an agreement with the largest oncology provider in the State to ensure that continuous cancer care could be provided to Athens’ area patients at a reasonable cost.  In the intervening time, NEGCC contracted to participate in Blue Cross and Blue Shield of Georgia’s (BCBSGA) Indemnity and PPO networks. After ending its HMO contract, NEGCC later tried to re-enter the HMO network after they realized that these services would be provided by another provider.

Today’s Insurance Meeting

NEGACC now wants the Court to apply the Any Willing Provider law and force Blue Cross Blue Shield of Georgia to offer HMO contracts to their medical oncologists. Today’s decision will show us if the ‘any willing provider’ statute is applicable to HMOs.  Stay tuned….