Prac­tice’s in­sur­ance move roils pa­tients

One Med­i­cal in D.C. to stop tak­ing CareFirst BlueCross BlueShield

The Washington Post Sunday - - METRO - BY COLBY ITKOWITZ

A pop­u­lar Dis­trict pri­ma­rycare group said it will drop the city’s largest health-in­sur­ance provider, leav­ing thou­sands of an­gry pa­tients to choose whether to find a new doc­tor or a new in­surer.

One Med­i­cal — a concierge-style prac­tice that, for an an­nual fee, prom­ises a more-ef­fi­cient, less-stress­ful doc­tor’s visit — sent a brief email last week to pa­tients in­form­ing them that, be­gin­ning Dec. 18, their CareFirst BlueCross BlueShield in­sur­ance would no longer be in-net­work, a change that would mean more out-of­pocket pay­ments.

CareFirst, which did not re­spond to a re­quest for com­ment, re­leased a state­ment plac­ing the onus on One Med­i­cal for “seek­ing dra­matic — egre­gious — in­creases in rates from CareFirst as well as ad­di­tional manda­tory charges from CareFirst mem­bers that would re­sult in mil­lions of dol­lars in ad­di­tional costs to mem­bers. Such cost in­creases at a time when many are al­ready strug­gling to pay for their health­care are un­con­scionable.”

One Med­i­cal chief ex­ec­u­tive Amir Rubin agreed to an in­ter­view about the sit­u­a­tion and then de­cided “for cor­po­rate in­tegrity and var­i­ous le­gal rea­sons we’re not go­ing to en­gage in a pub­lic in­ter­view about on­go­ing con­tract

ne­go­ti­a­tions,” said Vanessa Schenider, the prac­tice’s vice pres­i­dent of mar­ket­ing.

In­stead, the com­pany pro­vided a state­ment point­ing to a rise in health-care costs and pre­mi­ums that it said drove the need to raise rates: “These dy­nam­ics — which can dis­pro­por­tion­ately af­fect in­de­pen­dent prac­tices such as ours — dis­rupt our abil­ity to fo­cus on clin­i­cal ex­cel­lence and a great pa­tient ex­pe­ri­ence.”

One Med­i­cal, which began as a start-up in San Fran­cisco in 2011, has five lo­ca­tions in Wash­ing­ton, with a sixth sched­uled to open soon. It de­clined to say how many pa­tients it serves.

The prac­tice prom­ises to im­prove vis­its by elim­i­nat­ing long wait times in of­fices, of­fer­ing same-day ap­point­ments and al­low­ing on­line re­fer­rals and pre­scrip­tions.

The no­tice of the com­ing change cre­ated enough of a firestorm on so­cial me­dia that @onemed­i­cal was trend­ing on Twit­ter for a time Thurs­day. And with few de­tails of­fered for the shift, up­set pa­tients were split over whom to blame.

“I don’t think I’m over­stat­ing the fact that @CareFirst should give in to what­ever @onemed­i­cal wants #FIXIT,” read one tweet; an­other: “onemed­i­cal the world is al­ready ter­ri­ble! why did you make it worse!”

Robin Sum­mer started a Change.org pe­ti­tion, which col­lected more than 1,000 sig­na­tures in a day. It in­cluded a let­ter sent to the chief ex­ec­u­tives of CareFirst and One Med­i­cal.

“Re­gard­less of what led to the break­down in the re­la­tion­ship be­tween CareFirst and One Med­i­cal or who is to blame, the end of One Med­i­cal’s in­clu­sion as an in-net­work provider through CareFirst will be a sig­nif­i­cant prob­lem for many in the DC area,” the let­ter read.

Sum­mer, 41, said that it was her first time launch­ing a pe­ti­tion drive but she felt com­pelled to act when so­cial me­dia flared over the change and “it seemed like every­body in D.C. went a lit­tle nuts for a minute.”

An aim, she said, is “try­ing to show there is go­ing to be a cost here to both of your sides so fix it.”

Sev­eral sign­ers cred­ited One Med­i­cal for hav­ing the best LGBT care in the Dis­trict, some­thing it ad­ver­tises on its web­site.

While most pa­tients pay a $200 an­nual mem­ber­ship fee for the con­ve­nience of same-day at­ten­tion, for the past few years it has been waived for CareFirst mem­bers.

Mindy Moretti, 46, who is self­em­ployed and gets her in­sur­ance through the fed­eral ex­change, ini­tially paid the fee when she joined One Med­i­cal in 2013. She said it was worth it to be able to avoid the com­mon has­sles and frus­tra­tions of find­ing a good doc­tor with a com­pe­tent and car­ing of­fice that did not have long wait times for ap­point­ments.

“So when you find a sit­u­a­tion that is great, they’re con­ve­nient, they take my in­sur­ance, they work to­gether . . . no one wants to choose be­tween their health in­sur­ance and their doc­tors,” Moretti said.

That’s the sit­u­a­tion many CareFirst mem­bers find them­selves in now. For those who do not get in­sur­ance through work and shop on the mar­ket­place, like Moretti, do they switch to an­other car­rier so they can con­tinue us­ing One Med­i­cal? Or do they stick with CareFirst and find a new doc­tor?

A third op­tion is to con­tinue with both and pay out-of-net­work costs to keep their doc­tors, which would be $175 for the first visit and $125 for ev­ery visit af­ter that.

Deb­o­rah Chol­let, a se­nior fel­low at Math­e­mat­ica Pol­icy Re­search who has ex­per­tise in health in­sur­ance, said that it is im­pos­si­ble to know who is re­ally to blame in this par­tic­u­lar break­down. CareFirst has al­ready locked in its rate re­quests for 2018 based on how much it es­ti­mated pay­ing out to providers, so if One Med­i­cal was ask­ing for rates much higher than CareFirst an­tic­i­pated pay­ing, that may have led to their part­ing ways, she said.

CareFirst has op­er­ated with a nearly $1 bil­lion sur­plus for a decade, which ex­ceeds the ap­pro­pri­ate re­serve level by $268 mil­lion, and was or­dered by D.C. in­sur­ance reg­u­la­tors to in­vest a por­tion back into the com­mu­nity — which it has not yet done, Chol­let said. Fi­nan­cially, CareFirst could have enough money to ab­sorb the ad­di­tional One Med­i­cal costs by draw­ing from its re­serves, she said, but noted that there would be lit­tle in­cen­tive for the com­pany to do that.

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