Saturday, January 3, 2004

Alliance to pay patients' increase



By Dan Klepal
The Cincinnati Enquirer

The Health Alliance of Cincinnati moved Friday to hang on to patients insured by Anthem Blue Cross & Blue Shield who might be looking for new doctors and hospitals.

A contract between the Health Alliance and Anthem expired Dec. 31, meaning Anthem subscribers who use Greater Cincinnati's largest hospital and physician group would be paying higher "out-of-network" costs.

The Health Alliance announced Friday that it would temporarily cover the difference between "out-of-network" and "in-network" costs.

"It could be three months, or it could be less," said Health Alliance spokeswoman Gail Myers.

About 80 percent of Anthem subscribers have the option of using hospitals and doctors not in the insurer's network. Those who don't have the option may need to ask their employers if they can change health plans, according to the Health Alliance.

Emergency care is covered whether or not the Health Alliance hospitals are in the network.

The Health Alliance includes Christ, University, Jewish, St. Luke and Fort Hamilton hospitals. It also includes 90 primary care physicians and 2,000 Alliance physicians in more than 100 specialties.

Russell Dean, executive director for the Cincinnati Academy of Medicine, the association that represents about 2,400 practicing physicians in Greater Cincinnati, said the coverage announcement was significant.

"The fact that the Alliance is willing to pay the difference should eliminate most short-term damage" to patients, Dean said. "I've talked to both sides a lot, and they both seem determined to work out their differences."

The Health Alliance wants Anthem,, the region's biggest health insurer, to pay them more for their services. The insurer said its rates for medical care are competitive.

Although there are no new negotiations scheduled, officials on both sides said Friday they remain hopeful a deal will be reached soon.

"We certainly want to have the Health Alliance in our network," Anthem spokesman Joe Bobbey said. "As of a couple of weeks ago, we were very close to an agreement."

While the two sides continue trying to settle their differences, a two-year contract extension was finalized between Humana of Ohio and the Health Alliance on Friday.

The deal will give some 400,000 Humana clients access to Health Alliance services through 2006. Their current deal was set to expire at the end of 2004.

"We work to create more than just contracts with providers," Humana of Ohio President and CEO Larry Savage said in a prepared statement.

"We establish long-term relationships with physicians and hospitals in our network."

The Health Alliance provides detailed coverage information, including a list of Anthem plans with out-of-network benefits, on its Web site. Consumers may also call (513) 585-6464.

E-mail dklepal@enquirer.com




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