In the David-and-Goliath case of Missoula Radiology versus Blue Cross Blue Shield of Montana (BCBSMT), David is definitely overachieving. When BCBSMT charged the radiologists with operating a monopoly last fall, many members of the medical community saw the suit as just another example of the 800-pound-gorilla throwing its weight around. And many found it ironic that the state’s largest insurer would sue 12 local doctors under the monopoly pretense. In June 2003, Missoula Radiology had opted not to renew its contract with BCBSMT, and plenty of observers believed the suit was just an attempt to bully the radiologists back into BCBSMT’s provider network.
The local practice, though, refused to be bullied, and eventually the suit went to mediation. Now, the lawsuit is winding down and a hearing likely to make it go away is scheduled in Great Falls Federal Court March 30. The upshot? BCBSMT and Missoula Radiology have agreed to settle. The settlement must still be approved and signed by a judge, but as it stands the agreement, examined by the Independent, changes very little of Missoula Radiology’s day-to-day practice.
First and foremost, Missoula Radiology has not joined BCBSMT’s network (though its doctors continue to see BCBSMT patients and voluntarily reduce their fees to help offset the out-of-network penalty that BCBSMT charges its patients.) The settlement also mandates that Missoula Radiology comply with one business practice or another, but these “enjoinders” have roughly the same effect as absolutely, positively prohibiting pigs from flying, ever. Missoula Radiology, for instance, is “directed to rescind or otherwise eliminate” agreements that prevent its radiologists from leaving Missoula Radiology and practicing independently. Radiologists haven’t attempted to leave Missoula Radiology’s practice in the past, but now legally binding language tells them they may do so if they wish. The agreement also enjoins Missoula Radiology “from entering into exclusive contracts or agreements” with local hospitals. Hospitals are anxious to have radiologists on-call 24-7, but Missoula Radiology allowed its contracts with hospitals to expire a year and a half ago. Its doctors, though, still provide service as needed, even in the wee hours of the morning.
In many ways, Missoula Radiology has agreed to do business the way it’s been doing business for years. That outcome should be cause for celebration, but it’s probably bittersweet. Little David may have kept Goliath at bay, but unlike the original story, he walks away from victory, according to insiders, saddled with some hefty legal fees.