Wednesday, August 27, 2003

HMO negotiations break down

PROMINA Health System announced last week that its HMO negotiations with WellPoint-owned Blue Cross and Blue Shield of Georgia had collapsed over WellPoint's refusal to allow PROMINA physicians in its network.

As of midnight Aug. 31, PROMINA Hospitals, and those doctors contracted through PROMINA, will not be in the Blue Cross and Blue Shield of Georgia HMO Network. An estimated 34,000 Georgians will be affected by this change according to Blue Cross estimates.

"At the end of the day, these negotiations failed because WellPoint/Blue Cross has a proprietary stake in another physician network and did not want PROMINA's physician network competing with it," said Frank Rinker, President and CEO of Gwinnett Health System. "By taking the position they have taken, WellPoint/Blue Cross is saying to thousands of Atlanta health care consumers, 'We are not going to let you choose your own doctors; we'll choose them for you.'"

PROMINA urged WellPoint/Blue Cross to at least allow the patients to continue with PROMINA doctors until the first of the year. That way, patients can choose another plan or carrier during the upcoming open enrollment period. WellPoint/Blue Cross rejected that offer, opting instead to move patients to new primary care physicians immediately.

"To the patients, we want to express our deep regret for their inconvenience," says Frank Rinker, president and CEO of Gwinnett Health System. "Blue Cross put our patients and our physicians in a lose-lose position. We either accepted the contract without all of our doctors or accepted no HMO contract at all. Either way, the patients could lose their doctor."

In medical emergencies, members can still go to the closest emergency room and Blue Cross and Blue Shield of Georgia HMO members should be receiving other instructions from Blue Cross within a matter of days.