Document text
A pain for patients photo by Steve Johnson Anesthesiologists, insurers can�t get together on plan By Bill Kettler Beth Green�s skin cancer forced her to learn more about her health insurance than she ever wanted to. Green faced a substantial out-of-pocket cost for anesthesiology because her insurance company did not have a working agreement with Medford anesthesiologists. She spent hours on the telephone, talking to insurance officials and state regulators trying to find out how to reduce her personal costs. "You assume when you buy a (health) insurance policy, anesthesiology is included," the 55-year-old Talent counselor said. If Green had arranged her surgery last year, things would have been simpler. Since Jan. 1, Green�s insurance company, Regence BlueCross BlueShield of Oregon, has not had a contract with 19 local anesthesiologists who work together as Anesthesia Associates of Medford. Without a contract, Green and other people pay more for anesthesia. BlueCross requires members of some insurance programs to pay a greater share of the bills from "non-participating" physicians -- those who have not signed a contract. Charges for anesthesia are reckoned in part by how long a patient is anesthetized. Green faced particularly large bills for anesthesia because she expected to be unconscious four to five hours during skin cancer surgery. Her insurance would have paid 75 percent of the anesthesia charges if she could have found a "participating physician" who had signed a contract with Regence. She would have had to pay 50 percent of the charges from non-participating physicians, as well as 100 percent of any charges that her insurance company considered "unusual." Regence officials say Medford anesthesiologists have refused to accept the standard contract that has been accepted by other Oregon anesthesiologists. "They wanted things we were not in a position to guarantee," said Regence spokesman Ken Strobeck. "They�re the only guys in town," he said. "If they choose not to have a contract with us, it places our subscribers in a tough spot." Anna Tracy, office manager at Anesthesia Associates, said the lack of a contract has not prevented anyone from obtaining anesthesia. "We have to see everyone who comes through the door," she said. Neither Tracy nor Strobeck would comment on the issues that have prevented Regence and Anesthesia Associates from reaching agreement on a contract. Strobeck said negotiations continued for a long time, but have stopped. Just how many people the contract impasse affects is difficult to say. Regence offers several dozen insurance plans with different levels of coverage for specific services. Some plans, such as Blue Advantage (Green�s plan), PPO, and Traditional Coverage, pay less for services from non-participating doctors such as Anesthesia Associates. Members of those plans may pay more if anesthesia charges exceed Regence�s allowance. Other Regence plans, such as HMO Oregon and Blue Choice, do not charge additional copayments for services from non-participating doctors. Green resolved her dilemma by having her surgery in California while on a business trip. A physician friend offered to do the surgery and take whatever insurance coverage she could provide. "He told me I shouldn�t have to deal with all of this," she said. Obituaries | Sports | Business | Classifieds | Tempo | Prime Times | So Oregon Sites | Outdoor Journal | Subscribe | Contact | Movies | Advertise | Real Estate Showcase | Archive | Editorials | Letters to the editor | Religion | Wake-up Call | NIE | Cyber Chef | Job Network | So Oregon Weather | WSJ Northwest | Forums | AP Wire | AP Money | F.A.Q. | Awards Ottaway Newspapers, Inc. The Community Newspaper Subsidiary of Dow Jones & Co, Inc Copyright �The Mail Tribune 2000, Medford, Oregon USA