PHYSICIAN ASSISTANTS WIN IN COURT
Jul 17, 2004
Saturday, July 17, 2004
ANNA VELASCO
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 payments.