ASA Member
10+ Year Member
Apr 22, 2007
Attending Physician
Under some contracts, doctors don't have to agree to the new rates—they are automatically enrolled in the new networks. Other contracts give doctors as many as 90 days to opt out. Also, some plans are still offering the same rates as before.
How much leverage plans have to push down rates for physicians could depend in part on the number of consumers who sign up for coverage in the exchanges, which have gotten a slow start due in part to technical obstacles and a troubled rollout. If few people enroll in coverage, insurers may not need broad networks, but if enrollment soars, they may have to return to the negotiating table.
Blue Shield of California sent doctors contract amendments allowing them to opt in to treat exchange patients earlier this year. The health plan asked doctors to accept fees up to 30% lower than their normal commercial rates, according to doctors and the insurer.
"We said, this doesn't make a whole lot of sense for us," said Richard Thorp, an internist in Paradise, Calif., and president of the California Medical Association. Too few doctors agreed to the change in some mostly rural areas, so Blue Shield had to agree to continue usual rates for some doctors, said Steve Shivinsky, a spokesman.