Health Net, the California insurer, is dropping a large Orange County health system from its provider panel, forcing 30,000 members to find new doctors — or a new health plan.
Health Net's decision to end its relationship with St. Joseph Health System at year's end came after Bristol Park Medical Group left the system. Bristol Park accounted for 40 percent of the physicians in the St. Joseph system. Health Net says the loss of Bristol Park reduces access for its members and creates an unacceptable situation.
After Bristol Park left, the HMO asked St. Joseph for a rate cut, given its more narrow range of services. St. Joseph refused, prompting Health Net's move. St. Joseph was caught by surprise; normally, plans try to avoid disrupting blocs of members, but network instability is becoming more common (see State Initiatives, page 17).
St. Joseph last year dropped several money-losing contracts with health plans. After that, it had contracts with only four plans — then added Health Net as a fifth, last year.
Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweißen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.