Blue Cross settles state complaint

Blue Cross Blue Shield has agreed to stop using a physician-rating system, and has agreed to not penalize doctors for referring patients to out-of-network specialists under a settlement with the Texas Attorney General's Office.

Under the settlement, which was approved Thursday and announced Friday morning by Attorney General Greg Abbott's office, the health insurer does not admit any wrongdoing.

The announcement said that Blue Cross cooperated fully with the investigation.

In a news release, Abbott's office said that Texas law does not allow insurance providers to interfere with the patient's right to receive medical advice from his doctors.

According to the announcement, the patient has a right to receive - and the doctor has a duty to provide - the best treatment advice.

Blue Cross had employed a cost-based system, the Risk Adjusted Cost Index, to rank physicians on the basis of affordability in providing quality treatment and achieving a desired outcome for patients.

State investigators determined that the rating system was based on inaccurate information and a flawed method. That, according to Abbott's news release, misled patients about their doctors and penalized physicians whose patients suffered from expensive medical conditions.

Investigators also found that Blue Cross had threatened to terminate physicians for the sole reason of referring patients who needed specific treatments to specialists who were outside the insurer's provider network.

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HEALTH/Insurer will end physician-rating system deemed to hinder patient rights