Blue Cross Physician Reimbursement Schedule

BLUE CROSS/BLUE SHIELD (most)

To see the only good Blue Cross plan click Blue Cross/Blue Shield HMO Blue

Blue Cross Network

Current rating for PRIMARY CARE PHYSICIAN REIMBURSEMENTS--> * F

Their payments for OFFICE VISITS are--> * LOW

Their payments for LAB WORK are--> * POOR

---CURRENT RECOMMENDATION---

BLUE CROSS IS NOW ALMOST THE LOWEST PAYING NETWORK. PHYSICIANS, PATIENTS, AND EMPLOYERS WOULD BE WELL-ADVISED TO AVOID THIS INSURANCE LIKE THE PLAGUE.

THIS HAS BECOME REALLY BAD INSURANCE, AND THE STATE OF TEXAS SHOULD BE ASHAMED OF ITSELF FOR NOT TAKING BETTER CARE OF ITS EMPLOYEES!

-

---COMMENTS---

1/22/98 BLUE CROSS has reduced its payment for Audiometry (Hearing Testing) from $54 to $22, a drop of 59%. We assume that you do 230 of these tests a year, doctor; so Blue Cross just stole another $7,360 from your family and added it to their annual corporate profits.
------------------

12/11/97 All the best surgeons in Austin just quit Blue Cross (click)
------------------

11/25/97 BLUE CROSS just lowered its fee for an SGOT from $13 to $7, a drop of 46%. If you do three of these a day to monitor your patients taking drugs that could injure their liver, Blue Cross just increased its annual profits by another $4,140 at your expense. You do all the work and thinking, doctor. You take all the responsibility, but Blue Cross makes off with the money.
------------------

11/25/97 BLUE CROSS just dropped its payment for a Blood Glucose from $8 to $7, a loss of 12.5%. They know we must have that result when our diabetic patients are in the office; so they know we'll keep on doing the tests despite being paid peanuts. I suggest you look up the dictionary definition of "extortion". Seriously... do it! If we assume you do two of these tests in your office every day to monitor your diabetic patients, Blue Cross just stole another $460 from you and added it to their profits this year.
------------------

11/21/97 BLUE CROSS just dropped their reimbursement for a Urine Culture from $25 to $18, a decrease of 28%. Additionally, they pay nothing for a Sensitivity, claiming that it's a "part of the culture"; so you would actually hit negative cash flow if you billed a Urine C&S through your office. If we assume that you do three of these a week, doctor, then Blue Cross just screwed you out of another $966 this year. .
------------------

11/14/97
This just in from another of our Physician Correspondents:
It is rumored that all doctors at the Austin Diagnostic Clinic have been instructed by their business office to schedule no new Blue Cross patients because fee negotiations have not been successful. It sounds like the ADC is finally getting smart.

I encourage every Austin Primary Care doctor to take a very close look at this Blue Cross fee schedule to see if you think it makes sense for your office to continue seeing any Blue Cross patients at all (or at least any new ones). Also please see "What Can Doctors Do?"
-------------------

11/6/97 From one of our growing network of Physician Correspondents: "Austin Ear, Nose & Throat Clinic, representing ten physicians, has officially terminated its contract with Blue Cross/ Blue Shield effective 11/4/97. Negotiations went on for more than 6 months after they unilaterally broke their contract last Winter. Although BCBS changed reimbursements for a few codes, they never made any significant improvement in the total fee schedule. The two parties were unable to come to an agreement. Austin ENT Clinic will still see BCBS patients, but only on an 'out of network' basis." REMEMBER, YOU SAW IT FIRST ON "MEDICAL BURNOUT"; so tune in often.

11/5/97 BLUE CROSS just lowered its fee for a New Patient Office Visit (99201) from $39 to $34, a drop of 14%. If you see 3 new patients every day, Blue Cross just erased another $3,450 from your bottom line this year and added it as profit to theirs.
--------------------

10/30/97 Blue Cross just lowered its payment for an Arthritis Profile (80072) from $51 to $33, a loss of $18 or 35%. Doctor, if you take care of patients with arthritis and do one of these tests every 4 days, Blue Cross just took another $1,035 away from your family this year and fattened their own profits with it.
-------------------

10/13/97 BLUE CROSS just reduced their payment for a Pregnancy Test to $10 which is below our cost.
---------------------------

10/8/97 This news was just emailed in from one of our "Physician Correspondents":

* A group of 27 General Surgeons in Austin have given notice of their intention to resign from the BCBS physician provider panel in November, 1997. These surgeons, some of the very best in Austin, will then be available to BCBS patients only on an "out-of-network" basis.

* Austin ENT Clinic, 10 physicians practicing Otolaryngology in Austin, have submitted their resignation from the BCBS physician provider panel, effective November, 1997. After that date, these leading physicians will be available to BCBS patients only on an "out-of-network" basis.

*Independent Pediatrics of Austin, 12 superior physicians practicing general Pediatrics in Austin, are no longer accepting new patients covered by BCBS into their practices. Continued participation in the BCBS plans for established patients is currently under review.

Good job of reporting, doctor. Every doc who has news like this, please email it to us; and we'll post if for the world to see.

EDITOR'S COMMENT: Patients, this is the kind of physician dropout we've been talking about on this web site, and you're only seeing the beginning. Any patient whose insurance plan falls below the "cut-off" line on our Insurance Company Comparison table should understand that they may soon be able to see their long-time Primary Care doctor only on a full fee-for-service basis -- no more of this $10 copay baloney. Doctors have been nice guys up to now, and all we have to show for it is steadily dropping insurance reimbursements.
---------------------------

10/8/97 Blue Cross is hinting that they may soon begin requiring electronic submission of all insurance claims to them. This would require that most doctors install expensive new computer equipment in their offices (at their own expense) and also pay a computer billing service for every claim submitted. Since Blue Cross is already one of the lowest-paying plans, it's not very likely that doctors will do this, preferring instead just to drop off the plan and go back to direct billing of their patients on a fee-for-service basis, then letting the patient mail in their own insurance claims for out-of-network benefits.
---------------------------

10/3/97 BLUE CROSS just reduced its payment for an Arthritis Profile from $51 to $33 or 35%. If a doctor does one of these a week, his annual takehome pay just went down another $828. All the companies are slipping in these sorts of reductions all the time, a little here, a little there. Most doctors are never aware of it as its happening because each individual event is too small to notice - at the end of the year, though, the bottom line impact is staggering. It's like being eaten to death by ants.
---------------------------

9/30/97 BLUE CROSS just reduced its payment for an FSH (menopause test) from $55 to $24, a 56% drop. Doctor, if you do one of these tests every week, Blue Cross just increased its annual profit by another $1,426 at your expense.
---------------------------

9/17/97 Blue Cross is now paying so little for lab work that they are below our cost for the following items:
Pap Smear, HIV, VDRL, PSA, Heterophile Titer, and Hemoglobin A-1-C. On most of the rest of our lab work they pay only a pittance above cost. We simply couldn't stay in business if the majority of our patients had Blue Cross insurance. We're probably eventually going to have to drop Blue Cross and go back to fee-for-service for these patients if the reimbursements don't improve.
---------------

9/16/97 Blue Cross has lowered its reimbursement for a Stool Guaiac test from $9 to $5, a decrease of 44%. Doctor, if you do three of these a day, you've just lost $12/day for 230 working days a year and Blue Cross has increased its profits another $2,760 right off your bottom line.
---------------

8/18/97
It just breaks my heart to see Blue Cross slashing their reimbursements because I'm probably going to have to drop them at some point, and a lot of my favorite patients (many state employees) have Blue Cross. The Office Visit reimbursements from Blue Cross have always been weak, but this used to be offset by their good payments for lab work. Now they've reduced their Office Visit payments even more and at the same time have slashed lab reimbursements so severely that they've essentially killed any profit we were able to make on it. The only thing that's keeping me from quitting Blue Cross is my loyalty to all those patients I've known for years, but THERE'S NO WAY I'D TAKE ON A NEW BLUE CROSS PATIENT. I need to take home a little more than $0.37 per hour!!

PLEASE NOTE: A different plan, Blue Cross/Blue Shield "HMO Blue" pays much better for both Office Visits and lab work and is an OK plan. Click to see a Comparison of these two plans.

-----------

PLEASE BOOKMARK http://home.earthlink.net/~austintxmd and check often for updates

NET PHYSICIAN INCOME

BLUE CROSS/BLUE SHIELD (most)

Blue Cross Network

If you saw patients only from this one company for a full year, this is what you would earn.

Maximum Number of Each Click to see ASSUMPTIONS on which these figures are based

You Could Perform Fee
They Pay Totals
For Year

___Service____
Per Year

Office Visits (99212) 4,140 30.00 $124,200

Physical Exams (99215) 690 102.00 $70,380 HOURLY

Total Possible Income from Office Visit Charges--> $194,580 $169.20 Income

Total OFFICE OVERHEAD (click)--> -$206,600 __-$179.65 Overhead

Net ANNUAL PHYSICIAN INCOME--> -$12,020 -$10.45 <-- Net HOURLY MD Income

Hourly Physician "Wage" (based on an 8-hour day)--> -$6.53

INSURANCE REIMBURSEMENT AMOUNTS
(including patient copay)

CPT Code Description 1995 Payment Current Payment CHANGE

99211 Office Visit, MInimal 24.00 15.00 -37.5% Payment For
<-- 4 Office Visits

99212 Office Visit (10min.) 32.00 30.00 -6.3% $120.00

99213 Office Visit (expanded) 47.00 43.00 -8.5%

99214 Office Visit (detailed) 64.00 64.00 Payment For One
<-- Physical Exam

99215 Physical Exam (40min.) 88.00 102.00 -15.9% $102.00

93000 Electrocardiogram 47.00 47.00 -$18.00 <-- What the doctor loses every time he does a thorough physical exam. See "Disincentives to Good Care"

94010 Pulmonary Function 50.00 44.00 -12.0%

85025 Complete Blood Count 19.00 14.00 -26.3%

81000 Urinalysis 8.00 6.00 -25.0%

80061 Cholesterol/LDL/HDL 55.00 18.00 -67.3%

80019 Chem-28 Profile 50.00 14.00 -72.0%

88150 Pap Smear 17.50 7.00 -60.0%

---------

Reprinted from: http://home.earthlink.net/~austintxmd

Introduction It's Not Insurance Any More Greedy Insurance Exec Dedicated Doc Graphic

Introduction for Doctors PPO or HMO - Both are BAD GUYS

Doctors Are the GOOD GUYS "Disincentives" to Good Care

Doctors' Income Business is Business

The Effect on Doctors What Can Be Done?

Send E-MAIL to AustinTxMD Compare Insurance The Latest Bad News

BLUE CROSS/BLUE SHIELD (most)
*To see the only good Blue Cross plan click Blue Cross/Blue Shield HMO Blue*
Blue Cross Network
Current rating for PRIMARY CARE PHYSICIAN REIMBURSEMENTS-->		*	F
	Their payments for OFFICE VISITS are-->	*	LOW
	Their payments for LAB WORK are-->	*	POOR
	---CURRENT RECOMMENDATION---
BLUE CROSS IS NOW ALMOST THE LOWEST PAYING NETWORK. PHYSICIANS, PATIENTS, AND EMPLOYERS WOULD BE WELL-ADVISED TO AVOID THIS INSURANCE LIKE THE PLAGUE. THIS HAS BECOME REALLY BAD INSURANCE, AND THE STATE OF TEXAS SHOULD BE ASHAMED OF ITSELF FOR NOT TAKING BETTER CARE OF ITS EMPLOYEES!
	-
	---COMMENTS---
1/22/98	BLUE CROSS has reduced its payment for Audiometry (Hearing Testing) from $54 to $22, a drop of 59%. We assume that you do 230 of these tests a year, doctor; so Blue Cross just stole another $7,360 from your family and added it to their annual corporate profits. ------------------
12/11/97	All the best surgeons in Austin just quit Blue Cross (click) ------------------
11/25/97	BLUE CROSS just lowered its fee for an SGOT from $13 to $7, a drop of 46%. If you do three of these a day to monitor your patients taking drugs that could injure their liver, Blue Cross just increased its annual profits by another $4,140 at your expense. You do all the work and thinking, doctor. You take all the responsibility, but Blue Cross makes off with the money. ------------------
11/25/97	BLUE CROSS just dropped its payment for a Blood Glucose from $8 to $7, a loss of 12.5%. They know we must have that result when our diabetic patients are in the office; so they know we'll keep on doing the tests despite being paid peanuts. I suggest you look up the dictionary definition of "extortion". Seriously... do it! If we assume you do two of these tests in your office every day to monitor your diabetic patients, Blue Cross just stole another $460 from you and added it to their profits this year. ------------------
11/21/97	BLUE CROSS just dropped their reimbursement for a Urine Culture from $25 to $18, a decrease of 28%. Additionally, they pay nothing for a Sensitivity, claiming that it's a "part of the culture"; so you would actually hit negative cash flow if you billed a Urine C&S through your office. If we assume that you do three of these a week, doctor, then Blue Cross just screwed you out of another $966 this year. . ------------------
11/14/97	This just in from another of our Physician Correspondents: It is rumored that all doctors at the Austin Diagnostic Clinic have been instructed by their business office to schedule no new Blue Cross patients because fee negotiations have not been successful. It sounds like the ADC is finally getting smart. I encourage every Austin Primary Care doctor to take a very close look at this Blue Cross fee schedule to see if you think it makes sense for your office to continue seeing any Blue Cross patients at all (or at least any new ones). Also please see "What Can Doctors Do?" -------------------
11/6/97	From one of our growing network of Physician Correspondents: "Austin Ear, Nose & Throat Clinic, representing ten physicians, has officially terminated its contract with Blue Cross/ Blue Shield effective 11/4/97. Negotiations went on for more than 6 months after they unilaterally broke their contract last Winter. Although BCBS changed reimbursements for a few codes, they never made any significant improvement in the total fee schedule. The two parties were unable to come to an agreement. Austin ENT Clinic will still see BCBS patients, but only on an 'out of network' basis." REMEMBER, YOU SAW IT FIRST ON "MEDICAL BURNOUT"; so tune in often.
11/5/97	BLUE CROSS just lowered its fee for a New Patient Office Visit (99201) from $39 to $34, a drop of 14%. If you see 3 new patients every day, Blue Cross just erased another $3,450 from your bottom line this year and added it as profit to theirs. --------------------
10/30/97	Blue Cross just lowered its payment for an Arthritis Profile (80072) from $51 to $33, a loss of $18 or 35%. Doctor, if you take care of patients with arthritis and do one of these tests every 4 days, Blue Cross just took another $1,035 away from your family this year and fattened their own profits with it. -------------------
10/13/97	BLUE CROSS just reduced their payment for a Pregnancy Test to $10 which is below our cost. ---------------------------
10/8/97	This news was just emailed in from one of our "Physician Correspondents": * A group of 27 General Surgeons in Austin have given notice of their intention to resign from the BCBS physician provider panel in November, 1997. These surgeons, some of the very best in Austin, will then be available to BCBS patients only on an "out-of-network" basis. * Austin ENT Clinic, 10 physicians practicing Otolaryngology in Austin, have submitted their resignation from the BCBS physician provider panel, effective November, 1997. After that date, these leading physicians will be available to BCBS patients only on an "out-of-network" basis. *Independent Pediatrics of Austin, 12 superior physicians practicing general Pediatrics in Austin, are no longer accepting new patients covered by BCBS into their practices. Continued participation in the BCBS plans for established patients is currently under review. Good job of reporting, doctor. Every doc who has news like this, please email it to us; and we'll post if for the world to see. EDITOR'S COMMENT: Patients, this is the kind of physician dropout we've been talking about on this web site, and you're only seeing the beginning. Any patient whose insurance plan falls below the "cut-off" line on our Insurance Company Comparison table should understand that they may soon be able to see their long-time Primary Care doctor only on a full fee-for-service basis -- no more of this $10 copay baloney. Doctors have been nice guys up to now, and all we have to show for it is steadily dropping insurance reimbursements. ---------------------------
10/8/97	Blue Cross is hinting that they may soon begin requiring electronic submission of all insurance claims to them. This would require that most doctors install expensive new computer equipment in their offices (at their own expense) and also pay a computer billing service for every claim submitted. Since Blue Cross is already one of the lowest-paying plans, it's not very likely that doctors will do this, preferring instead just to drop off the plan and go back to direct billing of their patients on a fee-for-service basis, then letting the patient mail in their own insurance claims for out-of-network benefits. ---------------------------
10/3/97	BLUE CROSS just reduced its payment for an Arthritis Profile from $51 to $33 or 35%. If a doctor does one of these a week, his annual takehome pay just went down another $828. All the companies are slipping in these sorts of reductions all the time, a little here, a little there. Most doctors are never aware of it as its happening because each individual event is too small to notice - at the end of the year, though, the bottom line impact is staggering. It's like being eaten to death by ants. ---------------------------
9/30/97	BLUE CROSS just reduced its payment for an FSH (menopause test) from $55 to $24, a 56% drop. Doctor, if you do one of these tests every week, Blue Cross just increased its annual profit by another $1,426 at your expense. ---------------------------
9/17/97	Blue Cross is now paying so little for lab work that they are below our cost for the following items: Pap Smear, HIV, VDRL, PSA, Heterophile Titer, and Hemoglobin A-1-C. On most of the rest of our lab work they pay only a pittance above cost. We simply couldn't stay in business if the majority of our patients had Blue Cross insurance. We're probably eventually going to have to drop Blue Cross and go back to fee-for-service for these patients if the reimbursements don't improve. ---------------
9/16/97	Blue Cross has lowered its reimbursement for a Stool Guaiac test from $9 to $5, a decrease of 44%. Doctor, if you do three of these a day, you've just lost $12/day for 230 working days a year and Blue Cross has increased its profits another $2,760 right off your bottom line. ---------------
8/18/97	It just breaks my heart to see Blue Cross slashing their reimbursements because I'm probably going to have to drop them at some point, and a lot of my favorite patients (many state employees) have Blue Cross. The Office Visit reimbursements from Blue Cross have always been weak, but this used to be offset by their good payments for lab work. Now they've reduced their Office Visit payments even more and at the same time have slashed lab reimbursements so severely that they've essentially killed any profit we were able to make on it. The only thing that's keeping me from quitting Blue Cross is my loyalty to all those patients I've known for years, but THERE'S NO WAY I'D TAKE ON A NEW BLUE CROSS PATIENT. I need to take home a little more than $0.37 per hour!! PLEASE NOTE: A different plan, Blue Cross/Blue Shield "HMO Blue" pays much better for both Office Visits and lab work and is an OK plan. Click to see a Comparison of these two plans.
	-----------
PLEASE BOOKMARK http://home.earthlink.net/~austintxmd and check often for updates

NET PHYSICIAN INCOME
BLUE CROSS/BLUE SHIELD (most)
Blue Cross Network
If you saw patients only from this one company for a full year, this is what you would earn.

	Maximum Number of Each				Click to see ASSUMPTIONS on which these figures are based
	You Could Perform		Fee They Pay	Totals For Year
	___Service____	Per Year	Fee They Pay	Totals For Year
Office Visits (99212)		4,140	30.00	$124,200
Physical Exams (99215)		690	102.00	$70,380		HOURLY
Total Possible Income from Office Visit Charges-->				$194,580		$169.20	Income
Total OFFICE OVERHEAD (click)-->				-$206,600		__-$179.65	Overhead
Net ANNUAL PHYSICIAN INCOME-->				-$12,020		-$10.45	<-- Net HOURLY MD Income
							<-- Net HOURLY MD Income
Hourly Physician "Wage" (based on an 8-hour day)-->						-$6.53

INSURANCE REIMBURSEMENT AMOUNTS (including patient copay)
CPT Code	Description	1995 Payment	Current Payment	CHANGE
99211	Office Visit, MInimal	24.00	15.00	-37.5%		Payment For <-- 4 Office Visits
99212	Office Visit (10min.)	32.00	30.00	-6.3%	$120.00	Payment For <-- 4 Office Visits
99213	Office Visit (expanded)	47.00	43.00	-8.5%
99214	Office Visit (detailed)	64.00	64.00			Payment For One <-- Physical Exam
99215	Physical Exam (40min.)	88.00	102.00	-15.9%	$102.00	Payment For One <-- Physical Exam
93000	Electrocardiogram	47.00	47.00		-$18.00	<-- What the doctor loses every time he does a thorough physical exam. See "Disincentives to Good Care"
94010	Pulmonary Function	50.00	44.00	-12.0%
85025	Complete Blood Count	19.00	14.00	-26.3%
81000	Urinalysis	8.00	6.00	-25.0%
80061	Cholesterol/LDL/HDL	55.00	18.00	-67.3%
80019	Chem-28 Profile	50.00	14.00	-72.0%
88150	Pap Smear	17.50	7.00	-60.0%
---------
Reprinted from: http://home.earthlink.net/~austintxmd


Introduction	It's Not Insurance Any More
Introduction for Doctors	PPO or HMO - Both are BAD GUYS
Doctors Are the GOOD GUYS	"Disincentives" to Good Care
Doctors' Income	Business is Business
The Effect on Doctors	What Can Be Done?
	Send E-MAIL to AustinTxMD	Compare Insurance	The Latest Bad News