QUESTION: Is the American Board of General Practice recognized by Health Insurance Companies, Managed Care Organizations and Hospital Staffs?

The American Board of General Practice regularly receives, from various health insurance companies, managed care organizations and hospital staffs throughout the United States, requests to verify the board status of a physician who has been designated either board certified or board eligible by the American Board of General Practice.

The American Academy of General Physicians* (the professional association that recognizes and accredits the American Board of General Practice) periodically receives reports from some of its members that their designation of board certified or board eligible status was accepted and recognized by a health insurance company, managed care organization or hospital staff to which they had submitted an application.

The American Board of General Practice does not maintain a directory of the different health insurance companies, managed care organizations and hospital staffs which have accepted and recognized the American Board of General Practice. This is because it is the opinion of the American Academy of General Physicians* that there is no valid reason for the American Board of General Practice not to be recognized or accepted by any health insurance company, managed care organization or hospital staff.

It should, however, be clearly understood by all persons, that each health insurance company, managed care organization and hospital staff determines its own credentialing criteria and such criteria may vary. In fact, the American Academy of General Physicians* has observed variations in credentialing criteria among health insurance companies, managed care organizations and hospital staffs. Variations in credentialing criteria have even been observed from state to state and region to region within the same organization.

If recognition or acceptance of the American Board of General Practice by a particular health insurance company, managed care organization or hospital staff is an issue for, or of concern or important to, any physician, then such physician should check directly with such health insurance company, managed care organization or hospital staff as to its specific credentialing criteria.

Obviously, since each health insurance company, managed care organization and hospital staff determines its own credentialing criteria and since such criteria varies from company to company, organization to organization and hospital to hospital and also from state to state and region to region, it is impossible for there to be any guarantee that any specific health insurance company, managed care organization or hospital in a specific region in a specific state will recognize and/or accept the American Board of General Practice.

If a member of the American Academy of General Physicians* has any problem with any health insurance company, managed care organization or hospital staff regarding his/her designation of board certified or board eligible status, then there are a series of letters the American Academy of General Physicians* will send directly to such health insurance company, managed care organization or hospital staff, upon the request of such member. The reason the American Academy of General Physicians* sends out these letters for its members is because it recognizes and accredits the American Board of General Practice.

It is the opinion of the American Academy of General Physicians* that these series of letters are helpful. These letters advise the recipient of the various recognitions and accreditations of both the American Board of General Practice and the American Academy of General Physicians*. These letters also advise the recipient of the various opinions of the licensed physician members of the American Academy of General Physicians* which opinions were adopted at annual meetings of the members and have been peer-reviewed and published on its website, and advise the recipient that counsel for the American Academy of General Physicians* has advised that these opinions should be recognized by most judicial courts as admissible expert opinions which may be used as evidence for the finding of fact.

If a member of the American Academy of General Physicians* continues to have any problem with any health insurance company, managed care organization or hospital staff regarding his/her designation of board certified or board eligible status, after all such series of letters have been sent out, then the American Academy of General Physicians* will provide such member with information pertaining to other options which he/she may wish to pursue. The American Academy of General Physicians* does maintain a list of attorneys who have expressed an interest in representing its members in these type of matters.