Emergency physicians in Virginia exit Blues network

A medical group breaks away from the state's largest private health plan, prompting area employers to try to foster a reconciliation.

By Robert Kazel, AMNews staff. Jan. 24, 2005.

The decision of a group of emergency physicians to leave a Blue Cross Blue Shield plan in Virginia has spurred so much public interest that the state medical society says it's helped enlighten the local population about the problem of meager insurance reimbursements.

The 17 physicians who constitute Fredericksburg Emergency Medical Alliance, and who practice together under an exclusive contract with Mary Washington Hospital in Fredericksburg, decided to leave the Anthem Blue Cross Blue Shield network Jan. 1 after they couldn't agree with the insurer on reimbursement levels.

The plan is a subsidiary of Indianapolis-based WellPoint Inc., the nation's largest private insurance plan, and is the largest health insurer in Virginia.

Physicians at the medical group felt that the departure from the network was unavoidable because, after more than seven months of negotiation, the reimbursement schedule Anthem offered them was 30% to 40% lower than what other commercial plans in the market were paying, said Drew Garvie, MD, president of the group.

"We were so far apart we felt we could never meet in the middle," he said.

The end of the contract meant that Anthem members are paying more for their emergency care at the hospital, because they will be billed by the physicians for the balance of the doctors' professional fees. Dr. Garvie estimated the average patient will pay $60 out of pocket for a visit to the emergency department, whereas before patients usually only paid a smaller co-payment.