BY TIM BONFIELD
The Cincinnati Enquirer
Anthem Blue Cross & Blue Shield has decided to drop 25 Tristate physicians from its most popular managed-care plans, a move that will directly affect hundreds of patients and will limit physician choices for thousands more.
The doctors were part of Anthem's Community Choice and Premier Series 200 plans, which include about 150,000 of the 360,000 Tristate residents covered by Anthem health plans.
The change will take effect Sept. 14, and will include surgeons, oncologists, orthopedists and ear-nose-throat specialists. Among the speciality groups to be dropped: Cincinnati Head & Neck Inc., a five-physician group; and Cincinnati Hematology - Oncology, a five-member group of cancer specialists.
Anthem's action has upset patients and doctors. After going through six months of treatment for breast cancer in 1997, Marilyn Brickner, a 62-year-old Green Township resident, found out last week she needs to find a new doctor for follow-up care. She liked the doctor she had -- Dr. Robert Cody, a prominent Tristate breast-cancer expert.
"I feel like they're breaking their contract," Mrs. Brickner said. "I chose a doctor from their panel. Now in midstream they're dropping him. It just makes you angry that they can jerk you around like this."
The kicker: In May, Anthem increased her health premiums.
Anthem's announcement is the latest in a string of bad news coming from the company. Earlier this month, Anthem announced plans to slash 300 to 400 management jobs. In late May, Anthem decided to drop 20,000 Medicare HMO members in 19 rural Ohio counties and parts of three others.
Anthem officials said Wednesday their latest action was a routine part of doing business, no different than what any other health plan does.
"We do network revisions all the time," said Terry Frech, director of network management. "We did need to downsize our (Series 200) product."
Anthem officials also said dropping 25 doctors should not be a big problem because the Series 200 network includes about 1,200 specialists and 1,000 primary-care physicians. In addition, patients in Community Choice can exercise a "point-of-service" option, which allows them to see non-network doctors, but charges a co-payment that can range from 10 percent to 30 percent of the bill.
The goal behind dropping the physicians was to "differentiate" Anthem's Series 200 product, which includes 40-60 percent of local specialists, from its Series 300 product, which includes more than 80 percent.
Mr. Frech would not reveal the entire list of doctors to be dropped, but said patients and doctors have been informed by letter.
Mrs. Brickner, however, said, "The only notice I got was from my doctor."
Doctors say they cannot get straight answers from Anthem about why they were dropped. Anthem's response: The insurer selects doctors based on geographic factors, the number of patients seen by the doctor, utilization trends, and whether they have close working relationships with other network providers.
Options for affected patients are limited.
Anthem wants patients to simply pick another doctor from its now-smaller network. For those going through treatment, especially cancer patients, Anthem will make "continuation of care" arrangements that will allow them to see a dropped doctor until their treatment is complete.
Whether dissatisfied patients can switch to other health plans depends on several factors, including whether employers offer any alternatives and whether competing insurers would accept the business. With a history of breast cancer that she didn't have when she signed up with Anthem in 1995, Mrs. Brickner said she doubts whether she could switch to a different insurer now even if she wanted to.
