HMSA facing
possible revolt by
isle doctors

A group of health care providers
is accusing the medical insurer of
wielding too much control

By Helen Altonn
Star-Bulletin

A patients' advocacy organization is fighting the state's largest medical insurer on two fronts to loosen what it says is a "steel grip" on medical practice in Hawaii.

Protagonists in the battle are the 1,100-member Hawaii Coalition for Health and the Hawaii Medical Service Association, which has about 2,000 participating doctors and hospitals.

At issue is HMSA's contract with the medical providers. HMSA-proposed amendments to the existing contract are scheduled to take effect Jan. 31. The contracts determine how and how much physicians are reimbursed by HMSA.

But many doctors oppose the amendments and unless the problems are resolved, they won't have contracts with HMSA, said Dr. Arleen Jouxson-Meyers, coalition president.

Cliff Cisco, HMSA senior vice president, said, "We are reviewing objection letters and responding to each doctor individually, but no one is going to lose a contract or status as physician with HMSA."

Meyers said the coalition wrote to physicians just before Christmas informing them they could submit objections to the contract by Dec. 29.

The coalition also scheduled a meeting at 5:30 p.m. Tuesday at Kapiolani Medical Center for Women and Children to discuss the next steps, she said.

Judging by responses, she said, "We believe a substantial number of physicians, probably running into hundreds, have objected."

The coalition has hired the law firm of Garcia, Rosenberg & McKay to address the contract issues. HMSA has until Thursday to respond to the objections, Meyers said.

"If they don't respond satisfactorily, we will go forward and pursue this in litigation."

She said the coalition is required to use a binding arbitration provision in the contract.

The state Insurance Division also is moving ahead on a complaint filed by the coalition against HMSA months ago.

Cisco said HMSA received a letter from the state insurance commissioner Dec. 16 with the coalition's complaint. A written response is due Monday, he said.

Meyers, a pediatrician and attorney, said, "This is a turning point, in my opinion, of health care in Hawaii.

"This is an opportunity for physicians to take up their rightful leadership role. It will depend whether they come forward and do something. If not, we're doomed, and so are patients doomed, because you have an insurance company with enormous market power determining how health care is delivered, unfettered."

Cisco of HMSA said, "These are allegations of Arleen and her group."

"We don't believe it reflects the opinions of everyone," he said.

In its complaint to the insurance division, the coalition alleged HMSA was "engaging in unfair contracting practices and creating a business environment of coercion, intimidation and abusively exercising" monopoly power.

The group asked Insurance Commissioner Wayne Metcalf to order HMSA "to cease and desist from engaging in unfair practices," to impose fines and to suspend or revoke the insurance company's license.

HMSA maintains that the insurance commissioner's jurisdiction does not extend to private contracts, Cisco said.

"They can argue that; we'll listen to the argument," Metcalf said. "Our own review of the statute and the attorney general's advice is we do have jurisdiction in the matter."

The 1998 patient bill of rights law provides that health care plans are to be treated like any other insurance company with regard to unfair or deceptive acts or business practices or unfair competition, he pointed out.

Metcalf said a number of complaints about HMSA were received from individual health care providers, as well as from the coalition.