Post by unlawflcombatnt on Oct 5, 2007 2:32:18 GMT -6
from the Orange County Register:
Doctors are peeved at PPO
Some specialists are smarting after Blue Cross takes a bone saw to their reimbursements.
By COURTNEY PERKES
"Some Orange County physicians have canceled their contracts with Blue Cross, the state's largest health insurer, saying they can't afford to accept lower reimbursement rates that go into effect today....
But the change has prompted outcry from physicians and worries that patients will have to change doctors or pay higher costs for care. PPO patients can still see any doctor they choose, but they will pay more out-of-pocket costs if they opt for doctors who are not in the Blue Cross network.
Charles Denny, an Orange County healthcare consultant, said it's unknown how many doctors will cancel their contracts, if that will apply pressure to Blue Cross or if other insurers will follow suit. He said many doctors are trying to determine what will cost more – keeping Blue Cross or dropping it.
"They're not sharp business people in medicine, and they don't know how to cost this out," Denny said. "The story is only beginning Aug. 30."
The 15 surgeons at the Orthopaedic Specialty Institute in Orange did the math. They calculated the changes would amount to a 30 percent to 35 percent cut in reimbursement for knee surgeries and a 10 percent to 25 percent cut for shoulder surgeries.
It was a difficult decision, said Dr. Carlos Prietto, but the doctors mailed 4,800 letters informing patients that they were leaving the Blue Cross network and urging them to contact Blue Cross.
"We are on the same side as the patients," Prietto said. "(But) the morass between us and the patient is getting wider and wider and wider."....
Out-of-network costs can be more than double that for a "preferred provider."
"If enough physicians are not there to provide care, hopefully there will be enough patients complaining for (Blue Cross) to realize they need to change their business model," Rubin said.
Blue Cross, which is owned by Wellpoint, the Indiana-based health benefits giant, said the changes are an effort to increase pay for primary care doctors who earn less than specialists....
This month, the state Department of Managed Care held a hearing to air concerns about Blue Cross that have arisen after the 2004 purchase by Wellpoint. Doctors and patients protested the rate change, slow reimbursements and escalating insurance costs. Regulators heard testimony but have not taken any action.
"It's really kind of weird when they're raising the premiums and cutting what they pay for patient care," said Dr. Richard Frankenstein, president-elect of the California Medical Association and a Garden Grove pulmonologist. "We can't understand how that makes sense for the public."
Newport Beach oncologist Dr. Louis VanderMolen says he doesn't want to drop vulnerable patients undergoing chemotherapy. Blue Cross patients make up about 20 percent of his practice....
VanderMolen said Blue Cross is cutting rates for office visits by about 30 percent...
Already, VanderMolen said his office struggles to obtain timely approvals from Blue Cross for treatment, and reimbursements can take six months. For instance, he said a patient with colon cancer underwent about $100,000 worth of life-saving treatment before Blue Cross approved the procedures.
Other doctors echoed his complaint.
Internist Jim Fondren, who practices in Newport Beach, said Blue Cross recently dropped him after he wrote a series of e-mails about the difficulty of receiving approvals for tests.
"I basically said I've got so many cases where Blue Cross has denied X-rays, CAT scans and MRIs on patients that really needed them," Fondren said. "I thought they were putting all the doctors in a malpractice position. You make us go through all these ridiculous authorizations; you deny tests that are needed. We spend more time on the phone. We have to hire more staff to take care of your mess."...
In Fondren's case, he will still be able to see Blue Cross patients, but because he is now an out-of-network provider, his patients will have to pay more.
"I actually probably get reimbursed better," Fondren said. "Generally most of my patients say they're going to stick with me, but they haven't gotten their bills either.""
Doctors are peeved at PPO
Some specialists are smarting after Blue Cross takes a bone saw to their reimbursements.
By COURTNEY PERKES
"Some Orange County physicians have canceled their contracts with Blue Cross, the state's largest health insurer, saying they can't afford to accept lower reimbursement rates that go into effect today....
But the change has prompted outcry from physicians and worries that patients will have to change doctors or pay higher costs for care. PPO patients can still see any doctor they choose, but they will pay more out-of-pocket costs if they opt for doctors who are not in the Blue Cross network.
Charles Denny, an Orange County healthcare consultant, said it's unknown how many doctors will cancel their contracts, if that will apply pressure to Blue Cross or if other insurers will follow suit. He said many doctors are trying to determine what will cost more – keeping Blue Cross or dropping it.
"They're not sharp business people in medicine, and they don't know how to cost this out," Denny said. "The story is only beginning Aug. 30."
The 15 surgeons at the Orthopaedic Specialty Institute in Orange did the math. They calculated the changes would amount to a 30 percent to 35 percent cut in reimbursement for knee surgeries and a 10 percent to 25 percent cut for shoulder surgeries.
It was a difficult decision, said Dr. Carlos Prietto, but the doctors mailed 4,800 letters informing patients that they were leaving the Blue Cross network and urging them to contact Blue Cross.
"We are on the same side as the patients," Prietto said. "(But) the morass between us and the patient is getting wider and wider and wider."....
Out-of-network costs can be more than double that for a "preferred provider."
"If enough physicians are not there to provide care, hopefully there will be enough patients complaining for (Blue Cross) to realize they need to change their business model," Rubin said.
Blue Cross, which is owned by Wellpoint, the Indiana-based health benefits giant, said the changes are an effort to increase pay for primary care doctors who earn less than specialists....
This month, the state Department of Managed Care held a hearing to air concerns about Blue Cross that have arisen after the 2004 purchase by Wellpoint. Doctors and patients protested the rate change, slow reimbursements and escalating insurance costs. Regulators heard testimony but have not taken any action.
"It's really kind of weird when they're raising the premiums and cutting what they pay for patient care," said Dr. Richard Frankenstein, president-elect of the California Medical Association and a Garden Grove pulmonologist. "We can't understand how that makes sense for the public."
Newport Beach oncologist Dr. Louis VanderMolen says he doesn't want to drop vulnerable patients undergoing chemotherapy. Blue Cross patients make up about 20 percent of his practice....
VanderMolen said Blue Cross is cutting rates for office visits by about 30 percent...
Already, VanderMolen said his office struggles to obtain timely approvals from Blue Cross for treatment, and reimbursements can take six months. For instance, he said a patient with colon cancer underwent about $100,000 worth of life-saving treatment before Blue Cross approved the procedures.
Other doctors echoed his complaint.
Internist Jim Fondren, who practices in Newport Beach, said Blue Cross recently dropped him after he wrote a series of e-mails about the difficulty of receiving approvals for tests.
"I basically said I've got so many cases where Blue Cross has denied X-rays, CAT scans and MRIs on patients that really needed them," Fondren said. "I thought they were putting all the doctors in a malpractice position. You make us go through all these ridiculous authorizations; you deny tests that are needed. We spend more time on the phone. We have to hire more staff to take care of your mess."...
In Fondren's case, he will still be able to see Blue Cross patients, but because he is now an out-of-network provider, his patients will have to pay more.
"I actually probably get reimbursed better," Fondren said. "Generally most of my patients say they're going to stick with me, but they haven't gotten their bills either.""