Health Net and docs part ways

Dec. 07--In the wake of PrimeCare's ending its contract with Health Net Medicare Advantage plan, there is confusion and angst on the part of some patients.

Last week, PrimeCare, a 506-member Independent Physician Association, said it was ending its five-year association with Health Net Medicare Advantage on Dec. 31.

However, a Health Net of Oregon spokesman said Thursday, its subscribers have little to worry about.

"Recently there has been a lot of misinformation regarding Health Net of Oregon's Medicare Advantage plan coverage, and we want to ensure our members know the facts," the spokesman said. "Our Medicare Advantage members currently seeing a PrimeCare network doctor can still receive the same in-network coverage in 2019."

There are roughly 9,000 Health Net Medicare Advantage subscribers in Jackson County and another 6,000 in Josephine County. Most are seniors on Medicare, and some are patients with disabilities. Although a breakdown wasn't available, Health Net provides major coverage, while others use it as a supplemental insurer to cover the 20 percent not covered by Medicare.

In making the announcement, PrimeCare CEO Mike Bond said his organization had a positive relationship with the insurance firm, but had run into a series of issues after the company was acquired by Centene Corp.

Centene, ranked No. 61 in the Fortune 500, is publicly traded firm based in St. Louis that operates 50 healthcare organizations. Its 2017 revenue was $48.4 billion.

Health Net converted its operating systems to Centene last January.

"Unfortunately, those systems have proven to be incompatible, resulting in confusion in nearly all aspects of the relationship," PrimeCare said in its announcement. "Member offices have reported hundreds of hours of effort trying to resolve difficulties, only to have other difficulties arise."

Bond said legal restraints kept him from elaborating on what had been announced prior to Monday.

Doug Diehl, Asante Physician Partners' Chief Medical Officer, said the cancellation will effect subscribers in their current provider relationships. However, he doesn't anticipate a wild scramble for patients seeking new providers.

"I believe there are several things that have been done to mitigate this becoming a crisis," Diehl said. "All the physicians in Asante Physician Partners are open to Health Net subscribers, no matter what the product is."

He said many independent providers are still seeing Health Net patients, as well.

"Most important. Health Net is mitigating the situation by agreeing to treat all current subscribers and providers in network during 2019, while they work out the details and try to re-establish their relationship with PrimeCare."

Asante Physician Partners has 310 providers spread across primary care and specialty fields.

Diehl said Asante experienced similar electronic billing and claims issues earlier this year.

"It was very clunky for the first several months," he said. "But they have rectified number of problems. Health Net owned-up and made significant resources available to get things back to where they were Internally, we're seeing much smoother operation and claims pay."

Sparked by online and broadcast reports of the PrimeCare's move some subscribers immediately looked for other plans.

John Hallett, who has been with HealthNet the past five years, said he didn't want to risk losing access to his long-time doctor. The a former Medford City Council member who now lives in Grants Pass said he received a letter from his Ashland physician stating that after Dec. 31, he would have to pay for visits and then seek reimbursement from Health Net.

"You don't know if that will take, 30, 60 or 90 days, or if a provider will see you under those circumstances," Hallett said.

He had a supplementary policy with Health Net to cover the 20 percent Medicare doesn't pay.

To illustrate the importance of the supplemental plan, Hallett said he was considering a spinal fusion procedure, which he later spurned after a second opinion. Without a supplementary policy he would have had to pay 20 percent of $17,000 bill out of pocket.

A spokesman for Health Net said Thursday supplemental coverage was not part of the canceled MedAdvantage plan, so it would not have been disrupted.

How many patients choose to migrate from PrimeCare providers is something competitors will be watching.

"We could not absorb 6,000 new patients overnight," Diehl observed. "Quite honestly, our evaluation is that we could absorb a significant number of their primary care patients between ourselves and other groups. There is still a significant independent number of physicians in the community who are part of PrimeCare that will continue to see patients."

Health Net of Oregon said its members do not need to switch health plans in order to remain covered when seeing a physician in the PrimeCare network, the spokesman said.

Medicare Advantage members with questions are asked to call 888-445-8913.

Health Net said people with its commercial plans will not be affected.

Reach reporter Greg Stiles at 541-776-4463 or [email protected]. Follow him on Twitter at @GregMTBusiness or www.facebook.com/greg.stiles.31.

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