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Doctor Group Terminates Low-Cost Medical Plans

September 29, 1988|JESSE KATZ | Times Staff Writer

Claiming that it is being hampered in its efforts to provide high-quality medical care, a group of Ventura County obstetricians and gynecologists is terminating its contracts with 19 low-cost health insurance plans.

The Ventura County Obstetric and Gynecologic Medical Group, a partnership of three doctors with offices in Ventura and Oxnard, explained the decision in a letter sent this month to 6,000 patients, about 2,000 of whom are covered by such plans.

Although the doctors stand to lose large numbers of those patients, they said restrictions in the kind of treatment being covered by the insurance companies were adversely affecting the quality of care they provided.

"This is something we've been anguishing over," said Dr. Richard A. Reisman, a partner with Drs. John C. Gustafson and Steven G. Coyle.

"I want our practice to offer old-fashioned, personalized care. It may not be the most efficient, but it's the most satisfying."

But a spokesman for Blue Cross of California, whose "Prudent Buyer" plan was canceled by the three doctors, said his company merely requires that physicians be held more accountable.

"I think this is extremely insensitive to the needs of their patients," said Brian Gould, senior vice president and medical director for Blue Cross. "We don't dictate medical practice. We just ask that the medical establishment justify its expenses."

While many local doctors never accepted low-cost health plans when they came into vogue in the early 1980s, a spokeswoman for the Ventura County Medical Society said it was the first example of a large cancellation that she was aware of.

The insurance plans, known as preferred provider or health maintenance organizations, are generally able to cover 90% to 100% of a patient's medical expenses by contracting with physicians at discounted rates.

In return, the physician is promised large numbers of patients.

Reisman, however, said the insurance companies can also dictate the number of diagnostic tests or length of hospital stays they are willing to pay for, restrictions that he says make it difficult to provide the kind of care he feels may be necessary.

"Many health plans are beginning to materially interfere in the practice of quality medicine by too often dictating what services or procedures may be provided, based upon financial criteria rather than medical appropriateness," stated the letter sent to the office's patients.

The three doctors said they would give patients up to 12 months to find a new physician or enroll in another plan.

Babies from current pregnancies will be delivered, they said.

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