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Medica Splits With Physicians; Aetna Drops 'Em

MANAGED CARE March 1998. © MediMedia USA
News and Commentary

Medica Splits With Physicians; Aetna Drops 'Em

MANAGED CARE March 1998. ©1998 Stezzi Communications

A large Minnesota physician group and Medica have agreed to part ways at the end of the year, forcing more than 15,000 people to choose between their health plan and their physician.

Family Health Services and Medica terminated their relationship after a dispute regarding patient autonomy. Family Health wanted to refer Medica patients only to its 15 clinics, 75 physicians and 250 specialists associated with the group. Medica countered that its Medica Choice plan gave some of those patients the right to select any provider without a referral.

Negotiations during the past year have been punctuated by Medica's resentment of a patient letter-writing campaign initiated by Family Health. Sample letters, distributed in Family Health waiting rooms, claimed Medica's X-ray and lab policies affected its ability to provide quality medical care. Family Health refused Medica's request to stop the campaign.

In Arizona, thousands of Aetna U.S. Healthcare patients are facing the same choice (if their employer offers them a choice): Side with your health plan or your doctor. A growing number of physicians in the state are refusing to re-up with the HMO, objecting to measures added to contracts as a result of Aetna's acquisition of U.S. Healthcare. The HMO is in the midst of a huge effort to standardize physician contracts.

Arizona primary care physicians are balking at seemingly tedious contract terms, such as how many chairs must be in a waiting room, or having to approve or deny all procedures recommended by specialists to whom the doctors referred patients. Physicians say this is an attempt to stifle referrals.

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