Doctors are getting letters from Blue Cross and Blue Shield of Alabama this week letting them know physician assistants' services will be covered, following a lengthy court battle the insurer lost.
The mandated coverage will be effective for treatment given Oct. 22 and forward and applies only to patients Blue Cross insures. The coverage does not necessarily apply to patients who are under employer-insured plans that use Blue Cross as their claims administrator. However, Blue Cross is alerting such companies that they can start covering physician assistants' services if they choose.
A physician assistant is a medically trained professional, usually with a two-year master's degree, who works under the supervision of a doctor. Assistants are licensed to conduct many of the same tasks as doctors, such as performing physical evaluations, ordering tests, assisting in surgery and prescribing most medicine.
A 1997 state law required insurers to pay for their services, but Blue Cross said the law didn't apply to it because a 1939 law that established the state's largest insurer wasn't also amended.
`The right direction':
A doctor and two of his physician assistants sued Blue Cross in 1997, and the case ultimately became a class-action suit. The Alabama Supreme Court ruled in July that Blue Cross must pay for physician assistants, and a circuit judge ordered Blue Cross in late December to let doctors know of the coverage.
Doctors won't start getting payments for the billed physician assistants' services just yet, though. Payments will be held in escrow until other matters of the case are resolved. One outstanding issue is whether Blue Cross owes for services performed from passage of the 1977 law until Oct. 22.
Paul Harrelson, president of the Alabama Society of Physician Assistants, said he expected resolution of the matters within months.
"This is a big step in the right direction," Harrelson said. "Access to care in Alabama, hopefully, will be improved."
The biggest disappointment among physician assistants is Blue Cross' decision to pay them 70 percent of the doctor's fee.
Rick Kilgore, a physician assistant who has represented the association in the case, said the Blue Cross payment will be the lowest in the country, while Medicare and other insurers usually pay 100 percent of the physician fee.
"Basically, in our opinion, it's another attempt by Blue Cross to discourage the use of PAs in the state," Kilgore said.
Kilgore said he hoped the reduced fee would translate into lower insurance premiums.
Jim Brown, a Blue Cross spokesman, would say only that he also hoped the lower fee would equate to lower health care costs.
Despite the reduced rate, Kilgore said he thought the Blue Cross coverage would entice more physician assistants to the state. Alabama has 300 or fewer now, compared to several thousand in other Southeastern states.
"There's a pent-up demand," Kilgore said.
The state's nurse practitioners have banded together to get Blue Cross to cover their care as well. Nurse practitioners are registered nurses with bachelor's and master's degrees in nursing. They have advanced training to perform many functions doctors do, under a doctor's supervision.
A coalition of nurse practitioners pushed last year in the Legislature a bill mandating coverage of their services, but it went nowhere. Since then, Blue Cross has started covering nurse practitioners' services for state employees and is working with the group to expand the coverage to all fully insured Blue Cross patients, said Lynn Chilton, president of the Bay Area Nurse Practitioners' Association and a professor at the University of South Alabama.
"We continue to be in negotiations," she said. "We are hopeful."