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A proposed bill would force HMO's to accept any qualified health-care provider.

January 29, 2002
By: Kathryn Handley
State Capital Bureau

JEFFERSON CITY - HMOs would be required to accept any qualified health-care provider under a bill that was debated in the Senate Tuesday.

The bill, sponsored by the Senate's only physican -- Marvin Singleton, R-Joplin -- said it would lead to greater assurance that patients would not be forced to drop their physicans when HMO plans change each year.

"What we're dealing with in this bill is an attempt to say, 'folks, we need to look at the issues of patients' safety, quality, satisfaction and choice,'" Singleton said.

But Sen. James Mathewson, D-Sedalia, said he was afraid the proposal would lead to higher medical costs if HMO's could not reject those with higher expense records.

Legislative staff have estimated that for state government, Singleton's bill would cost as much as $11.4 million more to provide state health care coverage for state employees.

Mathewson told the Senate he thought that figure was too low, although Singleton said it was too high.

Singleton said including more doctors in managed-care plans would foster competition, which would cause patient prices to go down.

"Monopoly has a tendency to make prices go up," he said. "If people have more options, prices will go down."

Catherine Edwards, executive director for Missouri Association of Health Plans, disagreed. She said patients' premiums would rise between 15 and 29 percent if the bill were passed because HMO's could no longer reject health-care providers with histories of expensive services. Another reason for the cost increase is that providers could no longer negotiate discounts with HMO's to control competition, Blue Cross Blue Shield spokeswoman Deborah Wiethop said.

Singleton said he is concerned with people in rural areas, such as his constituents in Joplin, who may not have any choice between specialists because there are so few in the area.

"Patients aren't getting what they're paying for," Singleton said.

Edwards said she is also concerned about offering patients alternatives in rural areas, but people can always run to another health-care provider.

"Consumers can vote with their feet," she said.

Wiethop said her company does not support bills of this type because they would not allow cost alternatives to patients.

Insurance company owner James Coyne said that the existing plans are to the consumers' financial advantage. Since the providers agree to a pricing structure, patients often pay 40 to 60 percent less than they would pay without the plan, he said.

Currently, customers can purchase a policy that includes all health-care providers. Coyne said few people purchase this policy because the cost is higher and there are fewer benefits.

Blue Cross Blue Shield has great membership in the Columbia-Jefferson City area and serves 2.3 million people statewide, Wiethop said.

Singleton said Blue Cross Blue Shield is only accountable to one group of people -- their investors. He said that managed health-care companies are concerned with profit, not patient care.

"They're afraid of quality, they're afraid of convenience, they're afraid of competition," he said.

Coyne disagreed. "I think he's totally off base," he said.

Columbia Nurse Practitioner Beth Lonberger, of Urology Consultants, said she can definitely see some benefits to Singleton's proposal.

Lonberger said she has had patients drive from Lake of the Ozarks and beyond just to go to her office because it was on their panel.

Both Singleton and Lonberger said they were concerned about patients being forced to change physicians mid-treatment because a doctor that was once covered by their plan was no longer on the panel.

"If they have to move to a different physician, the continuity of their care can be greatly interrupted," Lonberger said.

Wiethop said Blue Cross Blue Shield patients would not necessarily have to change doctors. She said her company looks at cases on an individual basis.

"It's not a guarantee, but we would be willing to look into it," she said.

After a minor amendment, the bill was placed on the informal Senate calendar Tuesday. Singleton said the earliest he plans to bring the bill up again will be in two weeks.