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HMSA to face
state inquiry on
doctors’ complaints

A health coalition objects
to proposed amendments
to physicians' contracts

By Helen Altonn
Star-Bulletin

The Hawaii Medical Service Association will appear before the state Insurance Division on Friday to answer charges based on complaints by the Hawaii Coalition for Health and others.

It's the first case of its kind here, being investigated by the Insurance Division under authority granted by the 1998 state Patient Bill of Rights law. The coalition, a patients' advocacy group representing 1,100 members, filed complaints with the Insurance Division about proposed HMSA amendments to its physician contracts to take effect Jan. 31.

The contracts determine how and how much physicians are reimbursed by HMSA. The coalition, led by Dr. Arleen Jouxson-Meyers, a pediatrician and attorney, argues that patient care is affected by HMSA's "steel grip" on medical practice in Hawaii.

HMSA, the state's largest health insurance carrier, has about 2,000 participating doctors and hospitals. The Insurance Division issued an order to HMSA show why it shouldn't be ordered to cease and desist from activities contained in its charges.

In a statement listing its objections, the coalition said the proposed agreement, "which is being virtually shoved down the throats of participating physicians in spite of widespread opposition and objection, is largely a contract of adhesion in which the physicians, forced by the power over their livelihood by HMSA, surrender their professional responsibility to HMSA.

"Physicians have no bargaining power because of anti-trust constraints imposed upon them, while HMSA exercises its monopoly power to jam this offensive and one-sided agreement down their throats."

HMSA Vice President Fred Fortin today said, "We fully intend to cooperate with the commissioner's inquiry but we do feel the charges posed by the coalition so fundamentally misrepresent HMSA that we are going to have to pursue a very vigorous defense here." He said HMSA intends to present substantial evidence at the hearing "that I think will convincingly and overwhelmingly show the charges by the coalition are false and have absolutely no merit."

At a pre-hearing yesterday, Insurance Commissioner Wayne Metcalf told the parties that 21 other complaints were submitted. He said all the cases will be consolidated if a division investigation shows they are identical.

Metcalf also granted a coalition request to intervene in the case. The hearing will be at 1:30 p.m. in the Department of Commerce and Consumer Affairs building, 1010 Richards St. HMSA declined an offer of "good offices" yesterday by Metcalf, who said it was an attempt to see "if certain commonalities can be found from differing perspectives that will allow the parties to resolve a complaint."