AMARILLO, TEXAS -- If you're insured by Blue Cross Blue Shield, you could soon be dropped by your doctor. Amarillo's largest medical group plan, Amarillo Medical Specialists, announced Wednesday it will leave the Blue Cross provider network.
AMS estimates it has about 11,000 patients in the area who list BCBS as either a primary or secondary insurance provider. Its offices are near NorthWest Texas Hospital.
Its doctors include specialists in adult primary care medicine, like kidney disease, lung disease, and diabetes; those doctors said the decision to leave the network makes them sick, but they feel forced into it.
"Basically they've had double digit pay raises by increasing your premiums every year and ours have actually overall gone down over that same period of time and it's just so think that it doesn't make economic sense," said Dr. William Biggs, the AMS Managing Partner.
We did contact blue cross blue shield, the company gave us this statement:
"We have received termination notices from Dr. Susan Neese and Dr. William Biggs, effective November 2010. Dr. Neese and Dr. Biggs are affiliated with Amarillo Medical Specialists. Our goal is to achieve a reasonable outcome that will allow us to fulfill our responsibility to members by helping to control the rising cost of medical care. We strive to be fair and reasonable. However, we are not able to accommodate the fee increases the physicians have asked for. We are disappointed we have not been able to reach an agreement in order to reach a positive outcome for all parties. Regardless of what the physicians decide, we will make access to care for Blue Cross members our number one priority. The physicians' decision will not affect our members' access to numerous other physicians in the Amarillo market."
If you do have Blue Cross and use AMS, those doctors said they will not accept any new patients, and will start phasing out the ones they do have in the next few months.
Statement by Dr William Biggs, Managing Partner
"Despite annual, double digit, premium increases by Blue Cross, the basic fee schedule used to pay physicians in our group has not changed in over 7 years. For many services we provide, Blue Cross pays us less than 7 years ago, and often pays less than the bare bones Medicare schedule. At the same time Blue Cross has caused increased costs as a result of Blue Cross mandating prior authorizations for simple, routine medications and tests. We have attempted to negotiate with Blue Cross on these items, and they have refused.
"Our principal services to patients are office and hospital visits. Our group physicians do not perform surgeries or any expensive procedures that are paid at higher rates by Blue Cross. The Blue Cross fee schedule in Amarillo has contributed to making it difficult for the Amarillo area to recruit and retain the doctors needed. We continue to lose area physicians in our specialties despite increased demand for our services.
"Virtually all of our group's doctors have the highest possible Blue Ribbon quality rankings by Blue Cross, and we have worked with Blue Cross to provide the highest quality, best accessibility, and most cost effective care available. Blue Cross has not shown any interest in further discussions with us, even though it is likely that Blue Cross will have an inadequate number of doctors in some specialties. We will continue to work with virtually every other commercial insurance plan available in the area."
We have given notice to Blue Cross that we no longer accept any new patients insured by Blue Cross carriers, except for medical emergencies. In order to have an orderly transition of care, our doctors will phase out of Blue Cross over a period of time.
This will allow time for Blue Cross enrollees to switch to a different insurance plan, attempt to arrange a new doctor, or obtain Blue Cross permission to see one of our doctors as "out-of-network."
The current schedule calls for Drs. Susan Neese and William Biggs to be the first to exit Blue Cross in November, with other physicians following in subsequent months.
Statement by Dr Alan Keister
"Given the increased demand for our services, despite the current recession, we are increasingly concerned over the physician supply in Amarillo as the baby boomers age and the total population grows. If healthcare reform is enacted, the shortage in Amarillo will become critical. The local Blue Cross payment levels are making this problem worse, as new doctors find other Texas cities provide better offers for them.
"We regret coming to this decision. It was not made lightly, and we felt that this was our last remaining option. We remain open to further discussions with Blue Cross. We are working hard to minimize the impact to our patients and we apologize for any disruption this causes."
List of affected doctors:
Internal Medicine - Adult Primary Care
Keister, Alan MD
Do, Nam MD
Norris, Steven, MD
Marck, George J MD
Neese, Susan MD (Termination effective 11/1/10)
Saralaya, Shilpa MD
Saralaya, Raj MD
Miranda, Hernan MD
Endocrinology, Diabetes & Metabolism
Biggs, William C MD FACE (Termination effective 11/1/10)
Dodson, L Edwin MD
Usala, Stephen J MD PhD
Brantley, Kenny M MD PhD
Arias, Cesar MD FACE
Nephrology
Maliha, Georges M MD Giron, Milton A MD FASN
Houseal, Luzma MD
Naguib, Tarek MD
Gynecology - Women's Primary Care
Archer, Emily MD, FACOG
Archer, Estelle MD, FACOG
Infectious Disease
Rodriguez, Pablo MD
Neurology
Schaeffer, Lawrence MD
Pulmonary Disease
Sahad, Jesus MD
Rheumatology
Plata, Carlos MD
