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Physicians terminate ties with Blue Cross
Reimbursement cuts hurt, specialists say
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As doctors throughout Ventura County send termination notices to Blue Cross of California because of cuts in insurance reimbursements, patients like Jesse Martin expect pain.
The 52-year-old retired sheriff's deputy from Ventura is in the middle of treatment with a cardiologist he's been seeing for close to three years. But the doctor is severing his ties with Blue Cross, and Martin will likely have to find someone new or dig into shallow pockets to pay for more of his care.
"I didn't retire because I'd won the lottery," said Martin, who retired for medical reasons and now works for a roofing company. "What it does is it kicks me right in the teeth; to be honest, right in the groin. It affects me dramatically."
Blue Cross' parent company, WellPoint, is the largest insurance provider in Ventura County, representing about 30 percent of the insured population, according to an American Medical Association study. It's unclear how many of those people could be forced to find new doctors, though a Ventura urologist predicted he would lose 100 or more patients.
More than 20 specialists in medical groups or independent practices told The Star they've sent notices that unless planned Blue Cross fee changes are modified, they'll end their contracts with the company.
"You get to the point where economically, it doesn't make sense any more," said cardiologist Jeff Brackett, referring to costs of staff, rent and other overhead that rise as insurance payments fall.
So if people covered by Blue Cross want to see Brackett, they'll have to find new insurance companies or pay the difference between his charges and what the insurance companies pay for an out-of-network doctor.
"The patients are caught in the middle," he said.
New fees to start in August
The new fee schedule was planned for June 1 but was pushed back to Aug. 6 when doctors complained to the California Department of Managed Health Care that they weren't given proper notice. Specialists say their payment for some services would drop more than 30 percent and below what Medicare pays.
Some of the doctors who have given notice still hope to renegotiate a higher payment plan. Brackett said his Cardiology Associates Medical Group was told there would be no more discussions.
Blue Cross spokeswoman Peggy Hinz said the new fee schedule increases payments for some services and cuts others, meaning about as many doctors will make more money as those who will not.
Reimbursement from Blue Cross to primary care physicians will increase while payment to specialists will be cut. That's part of an industrywide incentive to boost the inadequate number of medical students with plans to become primary care providers, Hinz said.
She said very few people have sent in termination notices throughout the state, far less than 1 percent of all doctors' practices contracted with Blue Cross.
She said the company maintains a network of 1,200 doctors for patients in Ventura County.
That's not particularly reassuring to Jack Woessner, a retired aerospace engineer who lives in Oxnard. He's covered by Blue Cross but plans to drop the policy in September when he'll qualify for Medicare.
If that government safety net weren't available, Woessner thinks he'd be forced to find a different urologist.
"I don't think anybody wants to do that," he said. "If you run your finger down the Yellow Pages, what are your chances of knowing whether or not the doctor where your finger stops is a good medical provider?"
Gaining too much power
As a family practice doctor in Ventura, Ted Hole is a primary care provider. He said some of his reimbursements will rise under the new Blue Cross fee schedule, but the payments still aren't enough to sustain his business, and he has to battle over authorizations of everything from medicines to X-rays. He's considering terminating his contract.
"It just gets to the point where you wonder why you went to medical school," he said.
The lament echoes throughout the medical community. Doctors say reimbursement rates from the government and throughout the insurance industry jeopardize their ability to make a living.
"After 33 years, I make less than half of what I did then for a prostate operation," said Cedric Emery of Ventura, who has sent a termination notice to Blue Cross and is considering doing the same with at least one other insurance provider. "I'm a third-generation surgeon, and I wouldn't think of encouraging my children to go into medicine because I don't want them to be unhappy."
Quality of care is compromised too, doctors contend. Because they get paid less, they have to see more patients and spend less time with them. They complain that insurance companies are gaining too much power over the kind of treatments a patient receives.
Affordable to employers
Industry representatives say reducing reimbursement is one way companies keep insurance affordable to employers. Nicole Evans of the California Association of Managed Care said threats of termination are sometimes just negotiation tactics. Usually, patients aren't affected because the disagreements are resolved.
Doctors say the current battle is different.
"We've never, never quit any insurance programs in the 18 years we've been here," said Dr. Lamar Bushnell of the California Cardiac Surgeons group in Ventura. He offered another explanation for why Blue Cross is reducing some of its rates:
"Because they can," he said.
Blue Cross says that it provides insurance for 187,000 people in Ventura County. Doctors say the massive customer base gives them power to set whatever fees they want, knowing that if doctors terminate their contracts, they'll lose many of their patients.
And the loss will hurt, doctors say.
"This is going to be a big disruption," said Dr. F. Ray Nickel of Ventura Orthopedics Medical Group. That group of orthopedic surgeons sent termination notices to both Blue Shield and Blue Cross and is now in negotiations with the latter company.
"We've been having this discussion for years now," Nickel said. "Finally this year we've said enough is enough.'"
Posted by socal2310 on July 1, 2007 at 1:15 a.m. (Suggest removal)
Doctors have one more option: drop all insurance, public or private. The savings of less paperwork and employee-hours logged wrangling for reimbursement will more than make up for the losses many doctors face: they usually wind up charging less.
Of course, larger medical groups and insurance companies will be in Sacramento pushing for regulations to reverse the trend. Hint: there's a reason you don't often see doctors offering cash discounts when they still accept insurance and Medi-cal.
Posted by Justme on July 1, 2007 at 7:55 a.m. (Suggest removal)
It is sad when you see Wellpoint, the parent company, posting huge earnings and they just keep cutting reimbursement to physicians and hospitals. I have been in negotiations with them, and they think because they are Blue Cross, they do not have to give or negotiate... because they are big bad Blue Cross... it is sad because when physicians terminate it is the patients that feel it, not Blue Cross
Posted by surfmedic91 on July 1, 2007 at 10:43 a.m. (Suggest removal)
Michael Moore is just as bad as Blue Cross. He makes movies that sell and will put any content together to make the perception of what he is trying to prove. He should really worry about the healthcare system because he will probably need it based on how healthy he is (or isn't).
Posted by clementine on July 1, 2007 at 11:45 a.m. (Suggest removal)
Blue Cross has to reduce payments to doctors because Blue Cross has to pay their CEO & high-up executives hundreds of millions of dollars in stock options. I was a temp at several Blue Cross/Wellpoint offices in the 90's. The female supervisors that I worked under were "mean", "unappreciative" & very "unfriendly". They treated me like I was invisible! They even fired me "as a temp" from their Newbury Park office because I applied for a permanent position in another department. When they told me to go to Human Resources, I complained about how unfriendly & unappreciative my "female" supervisor was - The woman in Human Resources said, "Yes" I know we have a problem. We're getting someone to come down to train them in how to treat people. I have NO respect for this company.
Posted by ebrockway on July 1, 2007 at 11:45 a.m. (Suggest removal)
Wonder how successful a class-action suit would be? If Blue Cross would get the hint that we shell out big bucks for health insurance and expect a few things to actually be covered?
Michael Moore? Get a life! You actually think that was a realistic depiction of healthcare in Cuba under Castro? LOL! Makes you wonder why Floridians don't swim the other way TOWARD Cuba. Gee, an anti-US Government filmaker goes to Fidel and says "Help me make a movie bashing my government?", and wonder what kind of propaganda would be cranked out?
Oops, got off topic.
r.gyurkovitz;
Why don't they give you a break for paying cash? Less headache for Drs to do so...
Posted by thesantafecafe on July 1, 2007 at 1:08 p.m. (Suggest removal)
I am a home-grown Ventura boy who relocated to Australia a few years ago. Here there is a healthcare safety net. And while private healthcare is available to pay the difference, complete healthcare is available for all. The cost? About a 3% tax on my income. Period. If I want to buy healthcover there is no wait for elective procedures and I choose the doctor. The level of care is GREAT. Doctors are not filthy rich. Neither are insurance companies. The max I pay for a prescription is $36.00. Although I have always been a conservative republican, I now see how it can work. And it works very very well.
Posted by thesantafecafe on July 1, 2007 at 1:14 p.m. (Suggest removal)
Oh, by the way, I had my right wrist operated on for CTS as a PRIVATE patient. No insurance, and paid the difference out of pocket. Total was 725.00. No typo here folks. $ 725.00. The Colonoscopy was $ 800 out of pocket because I have no healthcare. If I do buy it, the cost per family is about 350 per month, covering ALL medical, private room in hospital, dental and eyeglasses.
Australia is a nice place. Our restaurant serves steaks, ribs and Tex-Mex. It reminds the 100 or so Americans living in this town of the US 40 years ago.
Posted by socal2310 on July 1, 2007 at 2:30 p.m. (Suggest removal)
ebrockway,
It's far too complicated to get into here, but basically, a hospital or medical practice offering a cash discount could run afoul of laws prohibiting unfair business practices.
Posted by TOaksResidence on July 1, 2007 at 7:39 p.m. (Suggest removal)
So this is what happens when you have a bunch of corrupt greedy lawyers running the show. It's time to turn things around and make them and their stinking families squirm for awhile
Posted by Mark_Smith on July 1, 2007 at 8:29 p.m. (Suggest removal)
Typical. Millionaire clinicians, representing the highest median compensated field of work in this country, doing no harm to their pocketbooks make the volitional choice to abandon their patients and yet the patients can only defend them. People get exactly what they deserve. In this case it is zero access to healthcare secondary to physician idolatry and an allopathic oligopoly that works in its own interests to limit the supply of providers in order to enhance the earnings of its members. It is only when we start demanding a level of responsibility from the allopaths that is commensurate with the level of privilege that is afforded to them will we see such travesties as the subject case cease.
Posted by socal2310 on July 2, 2007 at 7:07 p.m. (Suggest removal)
Mark,
Of course, we all know the insurance companies are operating at a loss, lol.
The AMA oligarchy is aided and abetted by the insurance companies and government regulations (which, not surprisingly, both groups are continually lobbying for). It's called socializing costs while privatizing profits.
The only way to bring it down is if both the patients AND the doctors rebel (lobbying for a less porous government safety-net isn't rebellion, that's what they want).
Posted by pinky on July 4, 2007 at 11:59 a.m. (Suggest removal)
I am a business owner and we used to have Blue Cross they constantly raised our rates. Why do they continually raise our rates and then lower it to the physicians that provide us the service that we are paying for. I for one switched and I believe if more business switched from Blue Cross they wouldn't be able to do what they are doing. If you have blue cross go to your Human Resources dept and request them to switch. That is the only way anything is going to change. Doctors need to terminate but business owners need to do their part as well.
Posted by Mark_Smith on July 6, 2007 at 11:43 p.m. (Suggest removal)
So... What are the after-expense compensation rates for the providers quoted in the story? Particularly, I am referencing comments such as the following:
"Doctors say reimbursement rates from the government and throughout the insurance industry jeopardize their ability to make a living."
Making a living? Hardly. Yet, somehow I doubt this information will be provided as it would surely kill the contentions being made.
Posted by jnicoll on July 8, 2007 at 10:23 a.m. (Suggest removal)
Some good posts!... and Yes Moore is the only "SICKO". Too bad the media doesn't talk about the 90% of people who aren't unhappy with their plan and/or the rates, and don't have problems with "the health care system".
Blue Cross, Blue Shield, Health Net, and the legitimate health insurance companies make a profit and do the right thing (executive compensation and admin costs (15%) is a problem in all industries), they have low premium plans that do what they're supposed to do when subscibers and business benefits managers are paying attention and know when to "transfer the risk" and refinance their inforce plan rates. That's what major medical insurance is supposed to be for, let's not forget. It's not a free right to everyone beathing here in California. Let's get off the "vict-o-crat entitlement mentally" and help make more efficient the public/private systems we already have, and forget all the single payer government run, employer mandated, tax-driven nightmares that the people don't want and only the wacko politicians are in favor of because, oh sorry, I forgot, it's only politics.
Posted by Mark_Smith on July 9, 2007 at 8:56 a.m. (Suggest removal)
Drs. Brackett, Hole and Nickel... what are your current after-expense compensation rates? Please let us know, such that we can make an informed decision as to whether or not the abandonment of patients by you and your fellow providers is justified. Remember, your "ability to make a living" is being "jeopardized." One wonders... Does that mean that you would only have to drive a middling Ferrari instead of a Lamborghini?
Posted by ntsqd on July 9, 2007 at 9:34 a.m. (Suggest removal)
Seems to me that Insurance companies should, by law, be non-profit. Any other form of business model is going to maximize benefits to the company above any and all others.
Posted by mymy805 on July 11, 2007 at 1:15 p.m. (Suggest removal)
What is really awful is that Wellpoint is now laying off their employees and sending their work to India, so since they are cutting costs and saving additional money, they should be offering the doctors more pay and cutting patient co-pays/deductibles! So now the providers and customers will now have to deal with non Americans, who will also have your private information in a foreign country! It will take longer to resolve phone calls due to their lack of knowing English as well as an American customer service representative. So I think providers and patients should cut Blue Cross off completely!!
Posted by teesdin on July 11, 2007 at 5:03 p.m. (Suggest removal)
any one know if this will affect PPO holders? or only hmo
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