Health plans: All or nothing could be here to stay

Physicians still fighting this issue...employers driving the contracts as they try to negotiate the best all care agreements for employees...where does it end...and who can guess what is covered where...and will your physician honor the contract...they do have to make a living too....new contracts have usually represented changes in compensation somewhere along the line...BD 

In 2005, a year after UnitedHealthcare acquired Oxford Health Plans, it issued an ultimatum to New York-area physicians: take both plans or you can't participate in either. Internist Daniel L. Brook of New York City, who says he'd had problems with Oxford and didn't want to add another managed care plan, refused to sign with United. As a result, when his Oxford contract expired in October 2005, it wasn't renewed.

In California, physicians who want to participate in the PPO plans of United or PacifiCare, which United acquired in 2005, must sign a joint contract with both companies, according to the California Medical Association (CMA). Those physicians who are already in the PacifiCare network can remain in it without signing the joint contract; but they're considered part of the United network, and United members may see those doctors, the CMA says. United declined to comment on any of the points raised in this article.  Liza A. Shiff, a soloist in San Jose, CA, has found this to be true. She's refused to take contracts with all-products clauses, and most plans have been willing to bend, partly because she's one of the few female internists in her area who isn't with a big group, she says. But some of her colleagues, she notes, haven't fared as well. They've been forced to take products they don't want, such as those involving workers' compensation, "because they need to make a living."

Since most physicians and medical societies oppose all-products clauses, why do so many health plans still have them? While it's difficult to get insurance companies to speak about this issue, the biggest reason appears to be that employers—the plans' main customers—demand the broadest possible networks in all products that the insurers sell them. (Some plans have also tried "tiered" networks that include only the lowest-cost, highest-"quality" doctors, but they haven't caught on to any great extent.)

WellPoint's settlement pact, like Aetna's, says it won't require physicians to take its capitated HMOs as a precondition for participating in its fee-for-service products; it further states that doctors don't have to participate in its Medicare or Medicaid networks to be in its commercial plans. But Blue Cross of California still hasn't sent physicians revised contracts, and its existing agreements include a provision that requires physicians to treat patients with work-related illnesses or injuries, Wetzel says.

Health plans: All or nothing could be here to stay - Medical Economics