Neurology patients concerned over local insurance dispute

Watch report from Action News
November 22, 2013 6:58:22 PM PST
Patients are speaking out about a dispute between a local neurology group and the area's biggest insurance company.

There have been many disputes with different practices and different insurance companies, but most of the time, it is the patients who get caught in the middle.

Lisa Barmat has suffered chronic migraines for the past seven years. It forced her to leave her job as an attorney.

"When I get what I call a true migraine, I am just down for the count," said Lisa.

She says Doctor Brad Klein at Abington Neurological Associates was able to figure out a regimen of treatments that would keep her migraines at bay, but earlier this summer, she was told she would have to find a new doctor, or pay out of pocket to continue seeing Dr. Klein.

"So our costs keep going up but our reimbursement rates aren't matching in any way, shape or form," said Dr. Brad Klein.

Dr. Klein told Action News the practice had to cut ties with Independence Blue Cross, because he says their reimbursement rates were much lower than other insurers.

"We are small compared to other organization, so we can't negotiate effectively with Independence Blue Cross, whereas a large academic center may be able to obtain double the rates as us," Dr. Klein explained.

Independence Blue Cross gave us a statement saying: "We believe that our reimbursement levels to ANA are fair and competitive, but we also take seriously the need to balance the affordability of our products for our members and group customers."

A spokesperson says they gave patients 90-day notices, and a list of other neurologists nearby to choose from.

Barmat got a short extension, but now has to drive into the city to see another doctor who specializes in her condition.

She says she pays high premiums and feels she deserves better.

"It is just unfair that I am put in this position as are hundreds of other patients in this practice with my same condition," said Lisa.

Doctor Klein says the lower reimbursement rates also make it difficult to recruit new doctors to the practice because they can't pay as much as other areas.

He says he would like to see more transparency; meaning being able to see who gets what amount of money from health insurers and how the money is being spent.

Read the full statement from Independence Blue Cross below:

"Independence Blue Cross (IBC) and Abington Neurological Associates (ANA) exchanged proposals regarding contract terms that would allow ANA to remain in our network. However, ANA notified IBC that they would be terminating their agreement with us on August 1, 2013.

We value our relationship with the network physicians who serve our customers, but at the same time we put our customers first. We are committed to fairly and competitively compensating physicians and hospitals. And we believe that our reimbursement levels to ANA are fair and competitive, but we also take seriously the need to balance the affordability of our products for our members and group customers.

We understand and appreciate how personal a member's relationship can be with a physician, and we are very sensitive to any potential impact on our members or any disruption of care resulting from ANA's decision to end its agreement with us. We are working closely with our members so they may continue to have ready access to the quality medical care they need.

We successfully maintain contractual relationships with all other neurology physicians in our service area, including 75 individual neurologists within 10 miles of Abington. We encourage customers and members with additional questions to call our Customer Service at the phone number listed on their member ID card."

Dr. Klein and Ms. Barmat tell Action News the number of other neurologists available and accepting new patients in the Abington area is much lower than 75.


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