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Flinging accusations of greed and hyprocrisy, California physicians are squaring off with a leading insurer in a fight that could have repercussions for the national health care industry.
Blue Cross of California threw down the gauntlet last month when it abruptly reduced physician payments for various medical procedures by 5 to 6 percent. The move affects specialists under contract with Blue Cross's Prudent Buyer Plan, a preferred provider network (PPO) that has 1.8 million members statewide, including 115,000 in San Diego.
Angry physicians, who maintain that the Blue Cross move was made to bolster its new publically traded stock, are responding with threats of lawsuits and, in some cases, defection from the PPO.
"This is a purely arbitrary, heavy-handed action by Blue Cross," said Dr. Bob Hertzka of San Diego's Anesthesia Service Medical Group, a 156-member anesthesiology practice that voted last week to drop out of the PPO. "If we wink at this, we'll have 20 more notices coming from 20 other insurers."
Blue Cross estimates that the fee reductions will affect about 40 percent of the 34,000 physicians under contract with the PPO--3,400 of them in San Diego.
In a May 11 letter to the physicians, Blue Cross cites government health care reform pressures and a dramatic rise in physician billings for the changes.
Physicians counter that Blue Cross has donned the mantle of health care reformer to disguise a move to bolster the stock of its for-profit, managed care entity, WellPoint Health Networks, Inc.
WellPoint was organized last year to own and operate substantially all of Blue Cross's managed health care business, of which the PPO is the main revenue generator. Blue Cross raised $476 million in...