How many anesthesiologists does it take to strike a deal with the Washington area's health insurers?
About 100, hopes Steven Hopper, the head of the anesthesia department at Suburban Hospital in Bethesda.
Hopper is also the president of First Colonies Anesthesia Associates (FCAA), which has new contracts to staff the operating rooms at Suburban and at Shady Grove Adventist Hospital in Rockville.
What FCAA does not have are contracts with major private health insurers. As a result, people who have surgery at the two Montgomery County hospitals may find themselves with a bill for anesthesia that their insurer will not fully cover.
The previous groups at the hospitals did belong to several insurance networks, said Dan Koontz, an FCAA spokesman, but the fees doctors earned under those contracts had not changed in as long as 10 years.
"It's always been our intention to be participating with all of the insurance carriers," said Hopper, who noted that his group will grow to almost 100 in the next few months. "We have been negotiating with them as far back as November of 2003, [but] the insurers have really made no effort to negotiate in good faith with us."
Asked about its dealings with Hopper's group, CareFirst BlueCross BlueShield, the area's largest insurer, issued a statement, which said in part: "CareFirst's goal is to have all providers in our area as part of our networks. We are disappointed when any of them decide to not participate, making it more difficult for our members to receive affordable medical services. Our offers to First Colonies have been fair, competitive and in the best interests of our members."
Suburban Hospital is giving letters to patients warning them that "your health plan may either deny payment on your anesthesia services or pay only a portion of your anesthesia bill. You will be responsible for any amount that your health plan does not pay."
"Most of our bills are in the range of $500," said Koontz, and FCAA offers a discount of up to 25 percent when insurers reject claims for full coverage.
"Our anesthesiologists . . . deserve to be adequately reimbursed" for their services said Suburban spokeswoman Ronna Borenstein. "We understand that some of our patients might not be pleased with a higher [bill]," but "the number of complaints has certainly been extremely small" since the April switch to FCAA.
Options for those who want to avoid paying extra may include using Montgomery General Hospital in Olney. But perhaps not for long.
"Just like First Colonies is . . . making noise," said Montgomery General spokeswoman Lynne Myers, the anesthesiologists who serve her hospital say they are receiving "very inadequate reimbursement" under their network contracts.
-- Tom Graham
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