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Hospital looks at insurance alternatives

JOHN A. BAYLESS

Although negotiations between many area physicians and the Blue Shield insurance corporation have faltered, Tahoe Forest Hospital and Tahoe Health System are working to bring other insurance alternatives to the hospital district’s service area.

Tahoe Health System is a recent joint venture between Tahoe Forest Hospital and Barton Memorial Hospital. It includes a network of more than 100 physicians in all fields and negotiates with insurance companies as a group.

“The purpose of the system is to make sure we provide all the medical service we can to members of the community,”

Executive Director Pamela Newman of Tahoe Health System said. “We will evaluate national insurance carriers and determine if they are a good match for the community. If they are, we can offer them the network, with physicians in many different fields.”

She said the system seeks to bring different choices in health care to the community, so that every one can have health insurance.

“We just signed a contract with HealthNet, and we are currently looking at Hometown Health, Affordable and Kaiser,” Newman said. “This will be an accessible network for our community.”

Newman said she has been negotiating with Blue Shield on behalf of Tahoe Health System, but not much progress has been made. She said Blue Shield in the past year has cut many physician’s payments to 50 percent of the billed amount, and less in some specialties.

“If they want to continue doing that stuff, they need to go elsewhere,” Newman said. She said Blue Shield has indicated it has only a limited amount of dollars to spend in this area, and is not inclined to adjust its payback percentages.

“We would walk away happy if they would come away and pay us what they were paying before,” Newman said.

“We are not doing this to Blue Shield,” she said. “They are doing this to us, and to their membership.” She said the insurance company is hurting the community with its intransigence.

“When push comes to shove, you pay whatever it takes to keep them in the network,” Newman said. “They are doing the community a grave disservice by not negotiating with the doctors.”

Within a year, Newman said Tahoe Forest Hospital should be able to offer residents membership in a licensed Preferred Provider Organization and a Health Maintenance Organization.

“We are in the process of trying to purchase an up-and-running HMO/PPO,” she said. “We’re developing that product and will be able to offer it to the community.”

Five district hospitals, including Tahoe Forest and Barton Memorial, are participating in the planned purchase.

“We’ve signed a letter of intent with the owner and are now working on terms,” Newman said. “Then we will file with the Department of Corporations.” She said material modification will need to be made to the PPO/HMO’s existing license and approved by the Department of Insurance and the Department of Corporations.

“The physicians in the network have all agreed to be a part of it,” Newman said. She said the HMO/PPO will be a little bit more expensive than Blue Shield, because it is a local venture.

“We will go out there with a product that is reasonable and offers services, but not as a loss leader,” Newman said. “With my experience and the experience of the other people involved, we should be able to put together a plan which is good for the community.”

Sierra Sun E-mail: sun@tahoe.com

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