BY TIM BONFIELD
The Cincinnati Enquirer
About 3,000 Tristate seniors and disabled people will have to find new doctors after the Health Alliance of Greater Cincinnati and its Alliance Primary Care doctor group decided to pull out of the Humana Gold Plus Medicare HMO.
The change takes effect Dec. 31.
"I didn't just jerk open a book and go eenie, meenie, miney, mo. I picked these doctors with some thought. Now I have to change again," said Pam Henry, a 51-year-old Norwood resident covered by Medicare because she has several disabling health problems.
The bad news was purely a business decision. Health Alliance officials said they could not accept the contract terms offered by the Humana Gold Plus plan, although they would not specify which terms were objectionable.
Now, the Humana Gold Plus situation adds to a string of recent problems with Medicare HMOs experienced by enrollees in Greater Cincinnati and nationwide. Seniors who signed up with fast-growing, low-cost plans in the past two years are watching in frustration as many plans increase premiums, cut benefits and drop unprofitable markets.
In the latest change, about 150 doctors in Alliance Primary Care will no longer be part of the Humana Gold Plus network. That figure does not count about 25 Northern Kentucky doctors in the Associates in Primary Care group, who recently joined the alliance but still have their own contract with Humana Gold Plus.
That means there will be 1,170 doctors left in the Humana Gold Plus plan.
After Dec. 31, three alliance hospitals - Christ, University and Jewish - will no longer treat Humana Gold Plus patients. But three other alliance hospitals - the two St. Luke hospitals in Northern Kentucky and the Fort Hamilton-Hughes Hospital - will stay in the network.
Medicare HMOs burst into the Cincinnati market about three years ago, jumping from one Medicare HMO in town covering about 2,200 seniors in 1995 to eight plans covering about 37,000 people in late 1997.
Many of the plans attracted members by offering expanded prescription drug benefits and other services not covered by traditional Medicare, yet charging no premiums beyond what people already pay to be part of Medicare.
More recently, Medicare HMOs have been pulling back. The main reason: last year's federal budget set a 2-percent annual cap on how much Medicare would increase its payments to Medicare HMOs.
Earlier this year, Anthem Blue Cross and Blue Shield announced plans to drop 20,000 seniors in mostly rural Ohio counties who signed up for Anthem's Senior Advantage product. Anthem recently agreed to a compromise that will still drop about 13,000 members while charging higher premiums for decreased benefits for everyone who stays in the plan.
Those affected by the Humana Gold situation can talk to a Health Alliance insurance counselor by calling 585-6462.
