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Seniors face acute case of change
By WES ALLISON © St. Petersburg Times, published April 12, 2001 ST. PETERSBURG -- George B. Moore feels like he finally got settled. Now there's more upheaval ahead. After joining Humana Gold Plus in December, when his last Medicare HMO left town, Moore learned this week he must find a new plan or quit seeing his doctor at St. Petersburg-Suncoast Medical Group, where he has gone for 21 years. Suncoast and Humana's Gold Plus Medicare HMO are parting ways after failing to reach a new contract, disrupting coverage for up to 3,400 area seniors. Members must choose a new plan or find a doctor in Humana's network by June 1. "I've talked to about six people in our condo who all go with Humana. They're just like, 'What?' " Moore, 82, of Pinellas Point, said Wednesday. "Like if you run through a pile of chickens, they're clucking, feathers flying. They're really upset." The change will not affect the 3,400 Suncoast patients who have Humana commercial HMO or PPO plans, only those in the Medicare HMO. Suncoast Medical administrator John Jenkins said they could not agree on a pay structure: Humana wanted to pay Suncoast a set fee per patient each month. If those patients cost less to treat, Suncoast would keep the excess. But if the treatment cost more, the doctors would have to cover it. Suncoast wanted a fee-for-service contract, as it has with other Medicare HMOs, including BlueCross/BlueShield, AvMed, United Healthcare and Cigna, Jenkins said. Under that system, doctors get a set fee for each test, procedure or exam. Jenkins said Humana's offer would have required Suncoast to keep more than $1-million in reserve to cover potential costs. "We certainly want to manage the patient care as best we can and do it cost-effectively, but we're just not in a financial position to do that," Jenkins said. The multi-specialty group has 52 doctors, all but one at its offices on Sixth Street S, next to Bayfront Medical Center. Six more doctors are expected to join the practice this summer. Many seniors enroll in private Medicare HMOs, which offer more benefits than traditional Medicare and are paid for by members' premiums and the government. The HMO industry complains that Congress under-funds Medicare, and low payments from the government hurt its ability to provide service. That has caused Medicare HMOs to leave some counties altogether and drop doctors in others. This is the second major medical group Humana's Medicare HMO has dropped in Pinellas in the past year. Last May, Humana failed to reach an agreement with the Morton Plant Mease Physicians Hospital Organization, forcing about 3,900 customers to change plans or doctors. Suncoast and Humana said they are notifying patients who will be affected. Humana spokeswoman Pam Gadinsky said the Medicare HMO has about 3,400 patients at Suncoast, but six physicians now affiliated with Suncoast might move to another practice. If that happens, those doctors could stay with Humana and the number of affected patients would drop by half, she said. Regardless, Humana's network includes ample St. Petersburg-area physicians for those who must change, and the company has no plans to drop Medicare coverage in Pinellas County, she said. "We plan to continue having a network to meet the needs of our members," Gadinsky said. "We consider Tampa a growth market for us."
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From the Times South Pinellas desks |
