Patients’ group challenges
HMSA contract additions

By Helen Altonn

The Hawaii Coalition for Health is challenging two amendments to Hawaii Medical Service Association doctors' contracts that HMSA says are "relatively minor."

Dr. Arleen Jouxson-Meyers, a pediatrician and lawyer who heads the coalition said the patient advocacy organization is informing all HMSA physicians and members of the changes and filing an action with the state Insurance Division. She said the coalition received a letter from HMSA in October saying it didn't intend to change terms of the three-year contracts ending this year.

Another letter followed Nov. 29, reporting two modifications had been incorporated, she said.

Cliff Cisco, HMSA senior vice president, said he was surprised at the coalition's objections because the changes are "relatively minor."

"Basically, it's the same contract physicians signed three years ago," he said.

He said only two words -- "any" and "action" -- were added to the contract as it relates to disputes with physician members other than termination of an agreement.

The provision previously dealt with an HMSA "decision," Jouxson-Meyers said. If a member physician disagreed with a decision, such as denial of coverage for a patient or payment considered unfair, a written request for review could be submitted to HMSA's review committee of physicians, she said.

The clause now says a review request can be made if a doctor disagrees with "any decision or any action" by the insurer.

"If you file action against them in court, they're going to say in defense, 'Our review committee looked at this and nothing was wrong,'" Jouxson-Meyers said. The Hawaii Medical Association, representing more than 1,600 doctors, and two HMA members filed separate lawsuits against HMSA in August, alleging unfair and deceptive practices.

A Maui physician also filed a lawsuit against HMSA on Maui, "complaining about late payments, lowering reimbursement rates and other schemes HMSA has been using for years," Jouxson-Meyers said. She said the coalition has never challenged the review committee, but feels it's made up of "people beholden to HMSA."

Cisco disagreed.

"The review committee is staffed by community physicians who make decisions independent of HMSA management," he said. "We believe the physicians act fairly in their decision process."

The second change allows HMSA to use the federal arbitration act instead of the state law if a dispute goes to arbitration, Jouxson-Meyers said.

"We're still researching the 'why,'" she said, suggesting the changes may make arbitration more likely.

Cisco said the Legislature in the last session repealed the state arbitration statute that HMSA had been following and replaced it with another law.

"We chose to use the federal arbitration act rather than the new state one because the federal one is similar to practices we've been using in the past," he said.


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