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WINSTON-SALEM - In a case with possible statewide consequences, a midsized Winston-Salem physicians practice is suing Blue Cross and Blue Shield of North Carolina over what is deemed an industry-standard practice.
Piedmont Community Physicians (PCP), made up of 31 doctors in a variety of specialties, describes in its lawsuit how Blue Cross contracts with providers to form networks for its own insurance products. Such networks, which allow insurers to negotiate discounted rates from providers, are the backbone of this nation's managed care system.
The issue of contention is that Blue Cross sells access to these same networks to self-funded employer plans for which the insurer handles only administration and is not financially responsible. Companies that choose to self-insure are usually large (more than 500 employees) and take on the bulk of the financial risk of their workers' health care costs.
Dr. Alan Koontz, a physician with PCP member Piedmont Anesthesia and Pain Consultants, said his group raised the issue during recent contract talks with Blue Cross but was rebuffed. The suit was filed Nov. 14...