In a decision he hopes expands the numbers of doctors in health networks, Georgia’s insurance commissioner has sided with a physicians’ group over claims two local Blue Cross Blue Shield affiliates prohibited its participation.

John W. Oxendine

John W. Oxendine ruled in favor of Athens, Ga.-based Northeast Georgia Cancer Care (NEGACC) in its 2009 dispute with Blue Cross and Blue Shield of Georgia and Blue Cross Blue Shield Healthcare Plan of Georgia (BCBS).

NEGACC, a group of doctors specializing in the treatment of cancer and blood disorders, claimed that BCBS was violating Georgia’s “Any Willing Provider” law by denying the group’s participation in preferred provider organization (PPO) and health maintenance organization (HMO) networks.

The law grants doctors and healthcare providers who are licensed to practice and in good standing with state officials the right to become a participating provider.

“I want to see, and I’m sure consumers want to see, more doctors in their health networks, not fewer,” Oxendine said in a statement. “More doctors mean more choice for patients, and I think it’s clear that’s the intent of the Any Willing Provider law.”

In a statement to IFAwebnews.com, BCBS said it was “disappointed” with Oxendine’s decision, which it says “singles out” Blue Cross and Blue Shield of Georgia’s HMO product for different treatment than other HMO products.

“This decision significantly expands Georgia’s ‘Any Willing Provider’ statute and is an interpretation that does not reflect the language of the statute or the intent of the General Assembly,” the insurer said. “We are currently evaluating the legal implications of the DOI’s decision and are assessing what next steps are appropriate.”

BCBS has 30 days to appeal Oxendine’s decision.

In a public hearing held in February, both sides argued the matter with state regulators. The matter came to Oxendine’s office after the Georgia Court of Appeals ruled disputes regarding the regulation and supervision of HMO’s required filing with the state’s department of insurance.

While Oxendine’s decision did clear up the interpretation of state law, the regulator did not rule on the applicability of the law to HMO’s in general, but indicated he has the right to do so in the future, according to the department.