Georgia Blues ordered to explain fees, calculation method to doctors. (Briefing).

In a ruling that sets a precedent for all health insurers in the state, a Georgia trial court has decided that Blue Cross Blue Shield of Georgia must share its fee schedule and its methods for calculating payments with doctors participating in its plans.

The Georgia Blues was asking physicians to sign a contract the insurer would never sign itself, said David Cook, executive director of the Medical Association of Georgia. The association, which is the largest doctors' group in the state, filed suit against the Georgia Blues in 1997 after 12 physicians were given contracts that said the insurer could change its rates and physicians wouldn't know about it until they received a reimbursement check.

As a result, physicians had no bargaining strength in the market place, Cook said.

"It's a hostile environment for physicians," Cook said. Insurers' failure to disclose fee schedules is just one part of what makes it hard for physicians to run a successful business, and it's driving physicians into early retirement and lowering the number of people applying to medical school, he said.

Now, physicians can evaluate the fee schedule and make business-planning decisions, Cook said. They don't want to end their contracts.

The court gave Blue Cross Blue Shield of Georgia a deadline of May 29 to publish its fee information. The insurer must disclose enough information so participating physicians can calculate whether they've been fully paid, according to a statement from the medical association. In addition, promises for future payments must be disclosed to physicians for an exact amount or based on a formula that determines the exact amount.

"We've received the judge's ruling, and counsel is reviewing the court's decision and our alternatives," said Blues spokesman Charlie Harman, who said he didn't know what type of alternatives the insurer's counsel was reviewing.