Lawsuit seeks to stop Blue Cross from limiting provider networks and restricting members' access to health care

A lawsuit filed against Anthem Blue Cross, on behalf of thousands of California doctors, is asking the court to stop Blue Cross from limiting their provider networks and restricting plan members' access to health care, solely for the sake of increasing profits.  The lawsuit seeks to enjoin Blue Cross from preventing any physician who is willing to accept the terms of Blue Cross contracts, and meets Blue Cross' eligibility criteria, from becoming a Blue Cross provider.

As the lawsuit explains, an insurer's provider network (i.e., its network of contracted physicians) greatly influences the quality of care patients receive and also an insurer's costs and profitability.  The type, number, location, and availability of network physicians directly affects patients' access to timely and quality health care: the smaller the provider network, the less access patients have to physicians, and the more money the insurer retains as profit; larger provider networks do not restrict patients' access to physicians, but do result in increased costs to insurers.

Dr. Jeffrey Nordella filed the lawsuit after Blue Cross denied his application to become a Participating Provider.  Dr. Nordella met Blue Cross' eligibility criteria, had previously been a Participating Blue Cross Provider, and was willing to accept the terms of Blue Cross' provider contracts. Yet, Blue Cross told Dr. Nordella there was "no network need established in the area of his practice." Dr. Nordella contends this is mere pretext, because his practice is an "urgent care," and there are only two other urgent care facilities within ten miles of his office, the closest over three miles away.

Any Willing Physician Laws

The lawsuit seeks nothing more than what is already the law across most of the United States – i.e., "Any Willing Provider" laws. AWP laws require that healthcare insurers allow any providers who are willing to meet a plan's financial and educational criteria into their provider networks.

AWP laws have been enacted to counteract what is referred to as "physician deselection." Physician deselection is a method by which insurers and managed care organizations terminate, or fail to renew, physicians' contracts for the purpose of controlling physicians whose statistics show them to be unprofitable or who advocate strongly for patients' rights.

"Patients should have more doctors in their health networks, not fewer, because this means more choice and better health care for patients," says Dr. Nordella.  A statement by the California Medical Association confirms that:

"The cornerstone of the health care system is the ability of a patient to see a doctor.  The size, composition and distribution of the physician workforce in California is the foundation of a quality health care system.  Without a plentiful, diverse and well-distributed supply of physicians, access to health care services and quality of patient care will be diminished, and health disparities made worse."

The complaint, filed in Los Angeles Superior Court, was served on Anthem Blue Cross on September 29, 2010.