As the article states, physicians will be passing the extra cost to the patients due to the current payment structures. Some increases will be present, but what are they and do they cover large health ticket items? BD
Doctors object to lower reimbursements. The insurer says new rates will pay physicians at 'sustainable levels.'
Blue Cross "won't renegotiate," Nagel said. "They will say, 'You take it or leave it.' "
Blue Cross of California's latest antidote to rising healthcare costs isn't going down very well with physicians.
The state's largest for-profit health plan is set to roll back its payments for about half the services and procedures provided by physicians next month.
And many of the 53,408 physicians in Blue Cross' preferred provider organization (PPO) networks say that's a prescription for disaster.One Newport Beach oncology practice figures the new rates will result in a $400,000 annual loss on the cost of treating their Blue Cross patients, who make up 40% of its cases.
As a result, Newport Cancer Care & Medical Associates sent letters to those patients explaining that they would be expected to pay the difference between the reimbursement rate and the costs of their chemotherapy."If we're not getting reimbursed, we can't pay for the drugs for the other patients," Donegan said. "The pharmaceutical companies and the insurance companies are the ones who are truly the profit-takers, and we're caught in the middle. The patients and the physicians are caught in the middle."
Dr. Ralph Armstrong, an osteopathic obstetrician-gynecologist in Hollister, said the reimbursements for procedures he performs often are being slashed. Gall bladder removals and appendectomies, for instance, are set to be reduced 28%.Troughton said the new rates include almost as many increases as decreases. Primary care physicians will tend to fare better than specialists under the new rates, she said.
This reflects an industrywide effort to counter an emerging shortage of primary care physicians by raising the pay for these general and preventive care practitioners relative to specialists.
But even some primary care physicians say their practices will suffer under the new rates.The state Department of Managed Health Care's hearing is scheduled for Tuesday, Aug. 7, from 10 a.m. until 3 p.m. in the Carmel Room Auditorium at the Junipero Serra Building, 320 West 4th St., Los Angeles.
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