Readers Speak Out on Insurance Fee Changes

We like to hear from our readers. From time to time the Federal Diary prints a "speak out" column featuring your thoughts. The Nov. 26 and subsequent columns on planned changes in the Blue Cross/Blue Shield standard option insurance plan for federal employees generated lots of comments.

Among the changes, patients will pay 100 percent of the cost of an operation by an out-of-network physician, up to $7,500 "per surgeon, per surgical day." Currently the rate is 25 percent of what the company sets for a procedure, plus any difference between that and the billed amount.

Here are some of the letters addressing the change.

Doctors Opting Out

More and more physicians are opting out of health-care plans, including BCBS, simply because dealing with the insurance companies is so difficult and time consuming. Thus, more and more physicians -- especially the better ones -- are out-of-plan doctors. My own family doctor is considering going to a full cash-payment system with no health-care insurance involved at all. I might actually consider that. But, of course, he doesn't do operations, so I don't run the risk of having a huge bill from him. Not so with surgeons. Since reading your column, my wife and I are reviewing options and considering switching away from BCBS. . . . The change is outrageous, especially on top of a significant increase in the premium.

-- John Jennrich

Reston

War Against Surgeons

An unnoticed purpose of this change amounts to a War Against Surgeons. Using the federal employees as a weapon, CareFirst [the Blues' operation in the D.C. area] is attempting to force surgeons who do not participate to sign up with the Blues or face a great and intolerable loss of patients. In addition, they are effectively removing the only bargaining chip possessed by physicians in private practice when negotiating with CareFirst -- i.e., the threat of dropping out of participation. I would suggest that you investigate the number of orthopedic surgeons participating with the Blues in D.C. and Chevy Chase and check into the scheduled reimbursements for January 1, which will be below Medicare rates, and draw your own conclusion about the coming limited access for patients as physicians trim their practices, do office practice instead of surgery or seek early retirement. This area is already at the bottom of the national ladder of reimbursements by all carriers, and the inflow of new docs will slow, compounding the access-to-care issue.

I am a 71-year-old, actively practicing, CareFirst-participating surgeon, but why should I continue?

-- R. Marshall Ackerman, M.D.

Potomac