FIRST OPTION: CONTRACT ANGERS PATIENTS, DOCTORS
First Option Health Plan's "attempt to cut the pay ofThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
anesthesiologists by 20% has resulted in canceled surgery for
many patients in North Jersey, angering doctors and state health
officials," the Newark Star-Ledger reports. Many
anesthesiologists have refused to accept the fee cuts and have
not signed contracts with the health plan, which was recently
taken over by California-based Foundation Health Systems Inc..
As a result, First Option "canceled scheduled surgery for many
plan participants at several New Jersey hospitals recently,"
including a patient with a "dangerous aneurysm" and one with a
painful anal fissure. A spokesperson for Foundation Health
"acknowledged" that the "cancellations were part of a company
plan to get New Jersey anesthesiologists to accept a cut in
fees." Dr. Carl Restivo of the Medical Society of New Jersey,
said, "This is an outrageous situation. This company is playing
Russian roulette with scalpels and anesthesia equipment and
patients' lives." Star Ledger reports that "[i]f the matter is
not resolved, both the State Society of Anesthesiologists and the
state Medical Society have threatened legal action."
SEARCHING FOR A SOLUTION
The Star Ledger reports that "[s]ome of First Option
clients' operations were later rescheduled, but only after long
delays in which patients were forced to find new doctors and
hospitals." Senior state health officials have given First
Option "until today to explain how the company plans to change
its policies to come into compliance with state laws."
Foundation spokesperson Lisa Haines said yesterday, "We have been
working on the situation since January 20. We feel as though we
have resolved the issue and will communicate that to the
department tomorrow. We have reached agreements with the
ATTEMPT AT PRECEDENT
Some New Jersey doctors are worried "that if successful,
First Option and other insurance companies could use the same
strategy to force doctors in other specialties to accept pay
cuts." In a letter to state Health Commissioner Len Fishman,
Dr. Erwin Moss, executive medical director of the New Jersey
State Society of Anesthesiologists, said that First Option is
"using patients as pawns in a power play ... The anxiety and
stress caused by having their operations canceled the day of
surgery is cruel and unusual punishment" (Scott, 1/22).