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HMOs and Doctors Agree To Disagree — But Just Why?

MANAGED CARE October 1998. © MediMedia USA
News and Commentary

HMOs and Doctors Agree To Disagree — But Just Why?

MANAGED CARE October 1998. ©1998 Stezzi Communications

Schisms between HMOs and physicians in two states:

In North Carolina, Blue Cross and Blue Shield's Personal Plan HMO severed relations with MedPartners primary care doctors Oct. 13. The Blues rejected MedPartners' "demand" for a payment hike of up to 30 percent, while MedPartners blasted the insurer's "decision to negotiate ... through the media."

In Texas, 95 physicians in the Health Texas Provider Network will stop seeing Aetna U.S. Healthcare patients Dec. 31 because of a dispute over referrals.

In an interesting juxtaposition, these events played out as a California Public Employees' Retirement System report suggested that much physician dissatisfaction about HMOs is misplaced. Headaches could be avoided, the authors say, if physicians took more time to understand plans' referral processes. The study was carried out with help from HealthNet and several medical groups.