Health department challenges BCBS clause
Health department challenges BCBS clause
The New York Department of Health is questioning a contract clause between Blue Cross and Blue Shield of Rochester and doctors participating in its affiliated managed care plan, reports the Rochester Democrat and Chronicle.
The controversial clause in question is known as a "most favored nation" provision, which requires doctors who sign a contract with a managed care organization to give the lowest rate of any contracts it signs. Officials have expressed concern that the clauses, while legal, can limit competition in a managed care market.
Blue Cross contends that its contract would not require participating physicians to offer the lowest price, but to use the lower charges of rates guaranteed to other HMOs as an "opener" to renegotiate and reduce its overall budget with the doctors.
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