Kansas doctors say the quality of health care is sure to suffer if the proposed sale of Blue Cross and Blue Shield of Kansas to a profit-seeking insurance company takes place.
The Kansas Medical Society and Kansas Hospital Assn. have filed testimony with Insurance Commissioner Kathleen Sebelius calling for her to reject the sale of Blue Cross of Kansas to Anthem Blue Cross and Blue Shield.
The medical groups, which represent 4,200 physicians in Kansas and most of the state's 157 hospitals, say the sale would reduce the quality of patient care because Anthem denies more medical claims than Blue Cross of Kansas and relies upon a care model that restricts doctors in their treatment of patients.
The associations also said Anthem's takeover of Blue Cross of Kansas would result in higher premiums for policyholders, and additional costs for all Kansans because the state would be forced to provide health care for people who would drop the more expensive insurance.
The testimony from the associations praised the financial foundation of Blue Cross of Kansas and its high community profile and said there was no reason to sell the company.
Officials with Anthem, based in Indianapolis, and Blue Cross of Kansas denied the assertions made by the associations.
Graham Bailey, a spokesman for Blue Cross of Kansas, said, "For us to continue to be what everyone loves, we have to make this change."
Anthem, which has 8 million policyholders in eight states, has proposed buying Blue Cross of Kansas the state's largest insurer that covers about 700,000 people for about $190 million.
To take effect, the proposal must be approved by policyholders and Sebelius, who has scheduled a three-day hearing on the matter starting at 9 a.m. Monday at the Capitol Plaza Hotel in Topeka.
Anthem and Blue Cross of Kansas officials have touted the proposed sale as a way for Blue Cross of Kansas to maintain quality care and stay competitive in an insurance market marked by consolidation.
But Marvin Fairbank, director for contracted care at Stormont Vail Healthcare in Topeka, said Anthem relies on strict guidelines for medical care that would reduce the length of stay for many patients and prevent some from being admitted.
"In Topeka, there are approximately 50 percent more Anthem denials (of insurance claims for care) than BCBS (Blue Cross of Kansas) denials even though the number of claims submitted by BCBS far exceeds those submitted to Anthem," Fairbank said in testimony filed on behalf of doctors and hospitals.
Fairbank said Anthem requires outpatient treatment for certain chest pain conditions when admission to a hospital would be better.
Gene Meyer, chief executive officer of Lawrence Memorial Hospital and a board member of the hospital association, agreed that Anthem was more restrictive in allowing claims and treatment.
He said a small number of patients with Anthem coverage have been treated at LMH.
"We've experienced some problems" including denial of claims and disputes over how long a patient should remain in the hospital, said Meyer, who opposes the sale.
But Graham pointed to testimony by consultants hired by the Kansas Insurance Department that said Anthem has a good record of customer satisfaction in other states; complaints were below competitors; and the company maintained coverage in rural areas.
Graham, however, also disagreed with those consultants, who along with the doctors and hospital associations, claim that Anthem's purchase of Blue Cross of Kansas will lead to increased premiums.
The Insurance Department consultants said policyholders could expect increases of 6 percent to 7 percent more should Anthem own Blue Cross of Kansas, because Anthem would be under pressure from stock holders to increase profits.
Graham said that assertion is based on a false assumption that if not sold Blue Cross of Kansas would keep its rates steady. Graham said Blue Cross of Kansas has experienced losses in certain lines of insurance, which will require increases in premiums regardless of whether it is bought by Anthem.
By opposing the proposed sale of Blue Cross of Kansas, the doctors and hospital groups joined groups representing nurses and advocates for greater health coverage, which earlier had filed testimony.
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