Patients Lose In Eye Care Bill Dispute

By ANDREW JULIEN

July 7, 2000 Web posted at: 12:57 PM EDT (1657 GMT)

HARTFORD, Connecticut (The Hartford Courant) -- Mounting frustration over unpaid medical bills is driving eye doctors across the state to drop out of several plans run by two of the state's largest health maintenance organizations, limiting consumer choice at insurers that cover hundreds of thousands of patients.

The problem is a Waterbury-based company called OptiCare, which some doctors say is so far behind in paying bills that it no longer makes sense to do business with the company. OptiCare manages eye care in Connecticut for Anthem Blue Cross & Blue Shield and for ConnectiCare.

The dispute is already hitting Lucia Basquin hard. Basquin has struggled with eye problems typical of the elderly, having cataracts removed from her right eye a year ago and from her left eye this year. It's been a comfort to have a doctor she trusts.

But her ophthalmologist, along with others across the state, say they are in the process of dropping out of networks run by OptiCare.

	More from The Hartford Courant
	News @3 State News Business News Sports News Town News

"I feel pretty bad," said Basquin, of Torrington. "You do need your medical care - and you've been going to your doctor all the years."

At Elwin Schwartz's Middletown practice, the unpaid bills at one point totaled more than $100,000. Despite the fact that dropping OptiCare could cause problems for between 4,000 and 5,000 of his patients, Schwartz notified the company two weeks ago that he was out.

"It was a tough decision," said Schwartz, who is president of the Connecticut Society of Eye Physicians. "I don't want to lose these patients, obviously. But I can't provide medical services to them and expect them to pay if they need surgery or long-term medical treatment."

The problem has caught the attention of Attorney General Richard Blumenthal, who said he has received more than 30 complaints.

"We have begun an active and vigorous investigation of various possible abuses in OptiCare's billing practices," Blumenthal said. "One active area of our interest is OptiCare's failure to provide payment to doctors and other health-care providers."

An OptiCare official declined to answer specific questions, but said the company's top executives are working to resolve the issue.

"We acknowledge that there have been some issues related to claims processing," said Jason Harrold, the company's chief operating officer for managed care. "We are aggressively working on resolving these issues with Anthem and the provider community and are confident we will do so in an expeditious time frame."

"We have relationships with over 40 customers in 15 states within the managed-care industry who are satisfied with our level of service," he said.

Officials at Anthem Blue Cross & Blue Shield became aware of the problem earlier this year and immediately began working with OptiCare to expedite payment of all outstanding bills, said company spokeswoman Paula Ladano.

More than 400,000 patients in Anthem's commercial, Medicare and Medicaid HMOs have eye-care services provided through OptiCare, an Anthem subcontractor since 1996. Ladano said OptiCare officials attribute the delays to a systems problem.

"We're involved with the provider community and OptiCare to identify and assure that OptiCare promptly resolves their claims-processing issues," Ladano said. "We're expecting that the problems will be resolved in a timely manner and to everyone's satisfaction."

Anthem Blue Cross & Blue Shield is monitoring changes in the network of providers and will work with OptiCare to fill any gaps in service, Ladano said. She also said that doctors may return to the network once the payment issues are resolved.

"We would hope that OptiCare can resolve these problems and work to bring these providers back into their network," Ladano said.

ConnectiCare, in a statement, said the company is aware of the complaints and is investigating. The company has about 165,000 private HMO members in Connecticut, state records show, although company officials did not say Thursday how many are covered through OptiCare.

"It is important to us that our participating providers receive good service from our network vendors, and accordingly we have asked OptiCare to take steps to resolve the remaining issues," the company's statement said.

But it may be too late to prevent disruptions in the delivery of eye care to consumers across the state.

Deborah Osborn, executive director of the Connecticut Society of Eye Physicians, said she has heard from 50 to 60 ophthalmologists who have dropped out or are working on dropping out of plans managed by OptiCare. Because of contractual obligations, some doctors will continue accepting patients through 2000.

The Middletown, Willimantic and Torrington areas will be hit hardest by the withdrawals, Osborn said. She said the plans affected include commercial plans, Medicare HMOs and certain Medicaid plans. Specific payment arrangements can vary from plan to plan within an HMO.

For more Local news, myCNN.com will bring you news from the areas and subjects you select.

CT, New Haven, WTNH DC, Washington, WJLA MD, Baltimore, WBFF MA, Boston, WCVB MA, Springfield, WGGB MA, Boston, WHDH MA, Boston, WLVI MA, Springfield, WWLP NH, Manchester, WMUR NY, Albany, WNYT NY, Albany/Schenectady, WRGB NY, Binghamton, WBNG   NY, Binghamton, WICZ NY, Buffalo, WIVB NY, Buffalo, WKBW NY, Elmira, WETM NY, New York, NY1 NY, New York, WPIX NY, Rochester, R News NY, Syracuse, WIXT NY, Syracuse, WTVH NY, Watertown, WWNY NY, Watertown, WWTI   PA, Allentown, WFMZ PA, Altoona, WTAJ PA, Erie, WSEE PA, Harrisburg, WGAL PA, Harrisburg, WHP-TV PA, Harrisburg, WLYH PA, Harrisburg, WPMT PA, Philadelphia, WPHL PA, Wilkes-Barre/Scranton, WYOU RI, Providence, WNAC RI, Providence, WPRI