TENTATIVE ACCORD ON HEALTHNET

Alliance Blue Cross Blue Shield, MedAmerica HealthNet and individual providers have reached a tentative agreement to continue cooperating on providing medical care for HealthNet Blue clients.

Randy Ressel, Alliance Blue Cross Blue Shield's vice president of sales, issued a letter to brokers Friday announcing the agreement.

Reached at home Friday night, Ressel would not comment on the agreement.

Alliance Blue Cross Blue Shield has scheduled a formal announcement of the agreement for Monday, Ressel said.

He did say, though, that Alliance Blue Cross Blue Shield is "in the process of getting the word out" to employers and brokers.

Ressel said the agreement "should put the whole world pretty well at ease." He said, "We're real happy with it."

Ressel's letter stated that Alliance Blue Cross Blue Shield and MedAmerica HealthNet have reached an agreement in principle to continue the provider contracts between Alliance Blue Cross Blue Shield, MedAmerica and the individual providers -- hospitals and physicians who are part of the MedAmerica network.

The agreement means HealthNet Blue customers will continue to receive health care "under essentially the same terms" now in place, Ressel wrote, and providers will receive the same agreements.

Ressel's letter does not say how long the contracts will continue. MedAmerica HealthNet's bankruptcy on Dec. 31 triggered a 60-day termination clause that would have ended its contract with Alliance Blue Cross Blue Shield as of March 1.

Ressel does write that Alliance Blue Cross Blue Shield is "in the process of developing" an Alliance preferred provider organization (PPO) and a non-gatekeeper health maintenance organization (HMO) network in Southeast Missouri.

PPOs are similar to HMOs, except that patients do not require referrals to see specialists.

The plan in the works through Alliance Blue Cross Blue Shield would allow local PPO enrollees to use doctors or hospitals throughout the state, according to Ressel's letter. Under the present HealthNet Blue plan, enrolees must use providers in the MedAmerica HealthNet network to receive full benefits.

The group program also offers a variety of coinsurance and deductible options, Ressel wrote, and in-network office visits for $10.

Alliance, Blue Cross Blue Shield of Missouri's managed care entity, has traditionally had few physicians in the region.

No firm agreements have yet been signed, and the bankruptcy court hearing MedAmerica HealthNet's case must approve the agreement, Ressel wrote.

"We have every reason to believe that a definitive agreement will be signed and that the court will approve it," he wrote.

MedAmerica HealthNet's decision to file bankruptcy set off a minor panic as employers and employees in the region worried about their health care.

Wade C. Adams, MedAmerica's executive director, said the network was forced into bankruptcy after Alliance Blue Cross Blue Shield said it would be liable for half the losses incurred on the health-care contract for Missouri Consolidated Health Care Plan. Those losses were projected at $16 million through 1998 for MedAmerica HealthNet's share of the contract.

Adams and other MedAmerica principals complained that Alliance Blue Cross Blue Shield provided no financial or utilization information, and would not substantiate the loss claims on the Missouri Consolidated contract.

Adams could not be reached to comment.

The network of some 250 physicians and six hospitals was formed in 1995.