Advertisement - Click to support our sponsors.

HMSA makes changes
while hearings continue

By Helen Altonn
Star-Bulletin

The Hawaii Medical Service Association has made some changes in its disputed physician contracts while state hearings continue into allegations that it is engaging in unfair practices.

Complaints against the state's largest health insurance carrier were filed by the Hawaii Coalition for Health and about 21 other health providers.

Dr. Arleen Jouxson-Meyers, coalition president, was expected to be cross-examined by HMSA attorneys when hearings were to resume today in the Department of Commerce and Consumer Affairs hearing room.

She was testifying when hearings broke off last week. HMSA officials have yet to testify.

The coalition's complaint to the Insurance Division alleged HMSA was "engaging in unfair contracting practices and creating a business environment of coercion, intimidation and abusively exercising" monopoly powers.

The coalition action was triggered by amendments proposed by HMSA to its physician contract. They took effect Feb. 1 over opposition of many doctors.

HMSA says the coalition, a consumer advocacy organization, doesn't speak for most of its participating doctors and the charges "are false and have absolutely no merit."

Meyers said HMSA "is running around telling people this is about doctors fighting for higher pay" which "in itself is a misrepresentation ... We want a say in how our patients are cared for."

She said there are many mechanisms in the HMSA contract that will deter physicians from providing services needed by patients.

But she said HMSA made three concessions at the start of the hearings.

HMSA said it is reviewing provisions with physician advisory committees that would:

Allow an attorney to be present at an appeals hearing relating to credentialing decisions.

Permit an arbitrator to award costs and arbitrator fees. Previously, the costs were shared.

Provide for the Dispute Prevention and Resolution, Inc., an independent Hawaii arbitration firm, to conduct the arbitration if the HMSA and physician can't agree on an arbitrator within 30 days.

Cliff Cisco, HMSA senior vice president, said physicians were invited to comment on the participating provider agreement and some suggested language improvements relating to the arbitration provisions. "There may be more changes of a similar nature in the future," he said.

The coalition still seeks changes in some key provisions, such as one allowing HMSA to set fees unilaterally without being subject to review, appeal or arbitration, Meyers said.

The hearing is being held to determine if there is cause for state Insurance Commissioner Wayne Metcalf to order HMSA to cease activities cited in the complaint.