Managed Care


Physicians, Plan at Odds Over Autoworker Coverage

MANAGED CARE March 2005. © MediMedia USA
News and Commentary

Physicians, Plan at Odds Over Autoworker Coverage

MANAGED CARE March 2005. ©MediMedia USA

Physicians in Michigan are angry and vow that they're not going to take it any more. The Michigan State Medical Society and the Michigan Osteopathic Association are suing Blue Cross Blue Shield of Michigan after the health insurer cut

500 doctors from its provider network. That is about 5 percent of the physicians in the plan networks that serve the Big Three automakers, whose concern about the rising cost of health care prompted the insurer to make the move.

In the meantime, an additional 1,900 doctors quit voluntarily after the plan announced that it would reduce payments for a range of medical services, the Wall Street Journal reports. "They are trying to whittle away at the amount we can charge by forcing us to charge what they want us to," Betty Chu, MD, a gynecologist in Clarkston, Mich., tells the newspaper.

Robert J. Stomel, DO, the MOA's president-elect, says that the health insurer and the Big Three "believe they can force physicians to discount their fees without input as to how these arbitrary conditions may affect access of UAW members and their families to physicians of their choice."

But Lisa DeMoss, the senior vice president and general counsel for the insurer, indicates that physician performance is being used to decrease the ranks of the provider networks, saying that the plan "included some practitioners with less cost-effective patterns of care." She tells the Wall Street Journal: "Cost is an issue for all purchasers of health care products today. To the extent that you have a product that is not performing up to expectations, nobody is going to buy it."

This is the latest salvo in the Big Three's battle to cut the costs of health care. "We're pretty tough on how we purchase health care and despite that, our costs are going up a lot," John Devine, GM vice chairman and CEO, tells the WSJ.


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