Premier Plan Doctors who worked as primary care physicians for the now defunct health insurer The Premier Plan will bear the brunt of the almost $1.8 million owed to the plan's two other partners.
costs docs
A group of about 700 doctors owes
insurance plan partners Queen's
Health Systems and Hawaii Medical
Service Association about $1.8 millionBy Lyn Danninger
ldanninger@starbulletin.comFamily practice physician Dr. Bernard Chun is one of of those doctors.
About 700 doctors, including Chun, are members of the Queen's Physicians Group, a nonprofit group of independent physicians that had a stake in the plan along with Queen's Health Systems and Hawaii Medical Service Association.
Chun said he had no idea he owed $14,000.
"Every (doctor) I spoke to was shocked and it came as an absolute surprise to me," he said
The doctors were told they owe Queen's a total of $1.5 million and HMSA, $350,300.
The Premier Plan, which ran for about 6 years, ceased operations in January 2001.
HMSA vice president Cliff Cisco said money owed to his organization, which acted as an administrative partner handling claims processing and marketing of the plan, is to cover funds paid out on medical claims.
"We advanced payment to doctors and hospitals and paid claims incurred by the plan's members," he said.
Cisco said when the Premier Plan came into being, it was not unusual for doctors to share the risk with other partners, either profiting if a plan did well or, as in this case, paying if it lost money.
With a number of such plans in existence at the time, it was a very competitive environment, Cisco said.
"Unfortunately it came at a time when all health plans were facing higher utilization and costs and premiums couldn't keep up. So much of this was dictated by utilization and environment," he said.
HMSA is asking doctors to pay their portion of the money owed by Dec. 18. How much individual QPG doctors owe both HMSA and Queen's depends on their share of plan business.
The highest amount owed to HMSA by an individual doctor is $2,960.
For Queen's, the highest amount owed is $12,000.
In most cases, primary care physicians -- such as internists, pediatricians and those who work in family practice -- owed the largest amounts, rather than specialist physicians, due to the higher volume of patients they treated, according to Chun.
Chun said he knows of at least two other doctors who have been asked to pay back $15,000 each. Both work as primary care physicians, he said.
But with no kind of itemization showing how the amounts owed were determined, Chun said he's not ready to write a check -- particularly when the letter he received from QPG was not even signed by the organization's board members.
While HMSA wants direct payment for what it is owed, Queen's is willing to allow individual doctors who owe money to work off their financial obligation, said Harris Nakamoto, QPG chief operating officer.
Nakamoto said the plan's business took a long time to wind up because an independent audit had to be completed after all the claims were finally submitted and it was known the plan would lose money.
"There was a projected loss and it took so long because there was an agreement that before finalization there would be an audit. It needed to be researched before we could go forward," he said.
Losses or not, the demand for payment two years later is not sitting well with Chun and other QPG physicians. Naka-moto said he initially received about 50 telephone calls a day from doctors questioning the letter. Now the number of calls have dropped to about 10, he said.
Nakamoto said physicians were kept informed on what was happening with the plan through newsletters and the QPG board.
Even if that turns out to be the case, Wahiawa pediatrician and attorney Dr. Arlene Meyers, who is familiar with the situation, says there should be a full accounting from QPG of why the plan failed and an explanation of individual amounts now being billed to doctors.
"I think the whole thing is extremely strange. With no accounting, no one knows what happened at the dissolution of the QPG plan," she said.
Moreover, Meyers said that demands for money without any details or explanation would not be acceptable in any other business situation.
"If you did this to anyone else, they would laugh in your face," she said.
Maui Plastic surgeon Peter Galpin is vice president of another physician organization, Hawaii Independent Physicians Association. About 400 of the group's physicians also belonged to QPG. Galpin has been getting calls from those physicians.
Galpin said he wonders what happened to the assets of QPG and if the unreimbursed amounts still owed to doctors for medical services they performed were ever applied to the doctors debt.
"Most doctors I talked to said they performed services for QPG for which they were never reimbursed. There are a bunch of those claims that got left in limbo -- some amounting to several thousand dollars," he said.
Moreover Galpin wondered how those neighbor island physicians who owe significant amounts of money to Queen's could take the option offered of working off the debt.
So far about 20 of the doctors he has spoken to about the situation practice on Maui, Galpin said.
"At best, this was handled poorly. At minimum, there should be a full accounting," he said.