Wednesday, June 25, 2003

Southern Regional 'shocked' at HMO notice

With 18 days still left to reach agreement, the doctors and hospitals in PROMINA Health System were shocked to learn that WellPoint/Blue Cross had already sent out letters to approximately 31,000 HMO members claiming that negotiations between the parties were at an "impasse" that could result in PROMINA's no longer participating in the WellPoint/Blue Cross HMO/POS network effective July 1.

The letter was sent while PROMINA was awaiting a response in the latest round of discussions. "As far as we're concerned, we're still in active negotiations," said Gordon Church, president of PROMINA Health System. "It appears that WellPoint is using this letter to create patient anxiety as a negotiation tactic.

"On behalf of our patients, hospitals and doctors we have asked WellPoint to solve issues surrounding unusually high denial of medically necessary care and exclusion of many qualified physicians from their network," added Church. "In addition, we've asked them to adopt the Reward for Quality program that encourages providers to meet certain quality standards beneficial to patients."

"The attempt on WellPoint's part to cast this as an effort to retain affordable healthcare is disingenuous given their position in the marketplace as one of the most profitable health plans," said Ed Bonn, President and CEO of Southern Regional Health System in Riverdale. "WellPoint is a national for-profit insurance company with annual revenues in excess of $17 billion going after our patients and physicians. We, on the other hand, are a not-for-profit community health system with a 31-year history of providing quality health care to the residents of the Southern Crescent, including a substantial amount of indigent care.

"WellPoint's position is particularly perplexing given that other insurers in the market find our rates and terms to be very acceptable. In fact, CIGNA embraced and implemented the Reward for Quality program last year."

Though disappointed that WellPoint/Blue Cross has called this an impasse, PROMINA is continuing to try and resolve differences, representing the best interests of its patients.

Southern Regional Health System offers comprehensive health resources, including: Southern Regional Medical Center, a 406-bed, full-service hospital in Riverdale, featuring a state-of-the-art outpatient surgery center; The Women's Life Center; a Diabetes Resource Center and one of the busiest emergency departments in the state. Southern Regional also provides mental health, home health care, substance abuse treatment and surgery efforts through RiverWoods, Southern Regional Psychiatric Center; Southern Regional Homecare; and the Surgery Center at Mount Zion, located in Morrow. Southern Regional is also a member of PROMINA's network of physicians and hospitals that also includes Dekalb Medical Center and Gwinnett Medical Center.