Saturday, July 17, 2004
Birmingham News staff writer

A closely divided Alabama Supreme Court ruled Friday that Blue Cross and Blue Shield of Alabama has to comply with a 1997 law requiring insurers to pay for physician assistants' services.

Blue Cross has not paid physician assistants in most cases, saying the state's largest insurance provider isn't governed by insurance laws unless the separate 1939 state law that established Blue Cross is also amended.

Five justices of the state's highest court disagreed, especially since the physician assistant's law stipulated that it applied to Blue Cross.

"Those members of the Legislature voting for the bill and the governor who signed it into law would be astonished to learn that they were simply wasting their time, as BCBS's argument invites us to conclude," Justice Champ Lyons wrote in the majority opinion.

Four justices disagreed, saying lawmakers have specifically amended Blue Cross's statute in recent years when they intended insurance laws to apply to the company.

Physician assistant Rick Kilgore, who has been active in the case, said Friday's ruling would draw many more physician assistants to the state, increasing the numbers from the current 300 to several thousand as in other Southern states.

Paul Harrelson, president of the Alabama Society of Physician Assistants, also was delighted with the opinion. "It's pretty big," he said. "We will start to be able to be reimbursed by the largest insurer in Alabama."

A Blue Cross spokesman declined comment Friday, saying he had not seen the Supreme Court's decision.

Physician assistants are medically trained professionals, usually with a two-year master's degree, licensed to conduct many of the same tasks as doctors. They can perform physical evaluations, order tests, assist in surgery and prescribe most medicine if they practice under the supervision of a physician.

Kilgore said physician assistants could improve access to health care in Alabama, which he said is woefully underserved, especially in poorer areas where doctors don't locate.

"We're no longer going to be on the bottom," he said. "We're going to be able to get providers out in these rural areas and provide health care."

Blue Cross controls at least 70 percent of the private insurance market in the state. Other private insurers in Alabama already pay physician assistants, as do the government funded Medicare and Medicaid programs.

While Friday's ruling was a victory for physician assistants, other issues in the lawsuit are unresolved. The suit, filed in Montgomery on behalf of a doctor and two physician assistants, will go back to circuit court where plaintiffs hope it will become a class-action case. Then the trial court will have to decide how physician assistants' rates are determined, and if Blue Cross has to make back paym