SURGICAL GROUP QUITS HEALTHNET NETWORK; NO LONGER THE SAME, SAY DOCS

Cape Girardeau's largest surgical group, Cape Girardeau Surgical Clinic Inc., has notified Blue Cross Blue Shield that it will leave the HealthNet Blue provider network Oct. 1.

Sarah Holt, clinic administrator, said the physicians opted to leave because HealthNet Blue was originally developed as an insurance product to be sold through a joint venture between MedAmerica HealthNet and Blue Cross Blue Shield in 1994. MedAmerica HealthNet filed for bankruptcy in January, blaming losses suffered on Blue Cross Blue Shield's contract with Missouri Consolidated Health Care Plan.

MedAmerica HealthNet dissolved in March after reaching an agreement with BCBS that it would not be liable for any of the estimated $16 million in losses. BCBS opted to contract directly with the former members of MedAmerica HealthNet to continue offering the HealthNet Blue product.

MedAmerica HealthNet's dissolution is the reason Cape Girardeau Surgical Clinic is dropping HealthNet Blue, Holt said.

"Half of that partnership -- the physician piece -- no longer exists, so we don't think that it's appropriate for Blue Cross Blue Shield to continue to sell that insurance product when half of the partnership no longer exists," she said.

The decision "has nothing to do with reimbursements," Holt said. "The network got established under one premise, and now it's doing business under another premise."

Surgeons in the group include Drs. Robert S. Hunt, Franklin H. McGinty, L. McClune, Jonathon K. Foley, Ronald M. Richmond, Daniel G. Hafenrichter and John G. Adams.

Clara Webb Kinner of Blue Cross Blue Shield said the company plans to continue to offer the HealthNet Blue product in Southeast Missouri.

Holt said the physician-hospital network was forced out of business because BCBS did not give providers necessary information, including utilization information and profit-and-loss statements as had been agreed.

The group continues its contract coverage with other BCBS products, Holt said, and will not drop HealthNet Blue members, who make up "a fairly sizable number" of its patients. The group's patients also include Medicare and Medicaid clients, as well as people with no insurance, she said.

"Our intent is not to put our patients in a financial bind," Holt said.

She said the group is "taking a stand because they feel it's the right thing to do."

Holt said: "We're a small practice as practices go. We're quite surprised that Blue Cross had made such an event of our choosing to not be providers on one product."

But HealthNet Blue patients who see doctors outside a pre-approved list of providers will not receive contracted discounts for medical care.

Kinner said no other HealthNet Blue providers have chosen to leave the health-care network. Eight providers left because they moved out of the area or retired, she said.

Seventeen new providers have been added to the network as well as Pemiscot Memorial Hospital in Caruthersville, Kinner said.

BCBS doesn't anticipate other changes in the network, she said, but members are advised to make sure their health-care providers are part of the network if they want to receive contracted discounts.

Twelve surgeons remain in the HealthNet Blue network.