Friday, July 30, 1999
Surgeons pull out of Anthem Blue Cross
Mayfield Clinic: Reimbursements key
BY TIM BONFIELD
The Cincinnati Enquirer
In yet another sign of friction between health-care providers and managed-care health plans, Greater Cincinnati's most prominent group of neurosurgeons has decided to quit doing business with one of Ohio's biggest health insurers.
Mayfield Clinic, Cincinnati's largest group of neurosurgeons, has decided to drop out of nearly all the health plans offered by Anthem Blue Cross & Blue Shield. Letters to patients began arriving Thursday.
Mayfield's action, effective Sept. 1, dramatically shrinks the number of neurosurgery specialists available to many of Anthem's 390,000 Greater Cincinnati members. The Mayfield group includes 12 of the 21 neurosurgeons in town.
The dispute is strictly about money. In June, Anthem offered a new contract that Mayfield contends would cut reimbursement by 12 percent, making Anthem the lowest payer in town. This comes on top of reductions of more than 50 percent from all managed-care plans made since the early 1990s.
“All the managed-care companies have been reducing fees to us over the years. We're at the point now where we're not going to do that anymore,” said Michael Gilligan, Mayfield's president and chief executive.
Anthem contends that during a month of failed negotiations Mayfield asked for a 30 percent rate increase.
“We are disappointed in the Mayfield Clinic's decision to terminate its contract, but we believe our reimbursement levels are in line with others in the Cincinnati market,” said Anthem spokeswoman Amy Dawson.
Until now, the Mayfield Clin ic had been treating about 2,800 Anthem patients a year; roughly 14 percent of Mayfield's total patient volume. Mayfield will drop out of 20 Anthem products in Ohio, Kentucky and Indiana, but will stayin three others.
Many, but not all, of those patients will have to find a new doctor.
Anthem members whose plans allow them to see out-of-network doctors will still be able to see Mayfield doctors, if needed. However, they will be required to pay a larger part of the bill.
Meanwhile, Mayfield will continue treating Anthem patients who call for an appointment before Aug. 31, even if the appointment is scheduled after Sept. 1. In addition, Mayfield plans to keep its contracts with Anthem plans that are tied to Group Health Associates, a large local physician group.
This is the first time Mayfield has dumped a managed-care company, Mr. Gilligan said. But the move is one of several local signs of frustration with managed care.
Several independent pharmacists are fighting rate cuts from ChoiceCare/Humana. Two local psychologists have refused to see any more managed care patients. Local orthopedists have joined a union. And Anthem also has made headlines with recent cuts in its prescription drug benefits.
As the financial pressures mount, Mr. Gilligan predicts many patients will find themselves paying more out-of-pocket for medical care, through combinations of higher co-payments, benefit cuts and coverage denials.
“Employers are resisting price increases. Providers are resisting rate cuts.
“That means insurers will be passing on more and more expenses to the patient,” Mr. Gilligan said.
Help gives agencies warm feeling
Many cool centers empty
Electric fans aren't much help
Businesses boom, bust in heat
Where to get help from the heat
Tips for staying cool
How to conserve energy
Public pools
Summer's R-rated films tempt teens
Surgeons pull out of Anthem Blue Cross
Be prepared for school violence, sheriff warns
Butler eager to put jail inmates in tent
Evening, weekend parking rates fall
Former Ky. official to face theft charge
New site gives parents Web filtering information
Pet killed by mistake at shelter
Rape attempt has suburbs on alert
Cincinnatian added to series' cast
GET TO IT
Inland sailors find relaxation, success on Cowan Lake
'Push for Pencils' starts Sunday for school kids
She likes Florence but loves New York
Arson suspected in 2 Hamilton office fires
Ashland to give $2.5M to Kentucky universities
Bids on bears to brighten shelter for area homeless
City's growth draws candidates
Commissioners firm on airport
Fairfield happy with scores on advanced exams
Federal judge rebuffs nude club's opponents
Ft. Thomas approves new school
Goal: Link with history
Kiddie porn suspect linked to N.Ky.
Land buyout came with limits for township
Mt. Orab tap water defended
Pretty park replaces city water plant
Prisoner's letters provide clues to suicide
Retiring director saw library grow
Runner's therapy leads to victory
Tower controversy lingers
TRISTATE DIGEST
