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Letters to the Editor

May 10, 2010

Physician choice shouldn't be based on cost



To the editor:

I am writing to let my patients know of a recent difficulty I have had with a health insurer.

I am an OB/GYN and have practiced here along with my associate, Dr. Ann Tramontana, for 30 years and participate with just about every insurance carrier there is. We do this so that it is easier for our patients and they have lower out-of-pocket expenses when they come to see us.

Recently, we were notified by a particular health insurer that we were costing them more money to see patients in a comparative group of doctors throughout the metropolitan Washington, Maryland and Virginia areas. When I met with the medical director, we were told we were five-tenths above the average cost compared to other OB/GYNs.

While this was difficult for me to imagine, this health insurer decided to make us an out-of-network provider for patients with a specific plan with this health insurer so that patients who see us for things other than yearly checkups and who require any type of office procedure or surgical procedure will have to pay a greater share of the expense out of their own pocket.

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In their cost criteria for our practice, they include not just physician fees, but hospital and freestanding surgery facility fees, laboratory fees and radiological fees, which are beyond our control, but if higher, it makes it look like we are costing the health insurer more. This has resulted in longtime patients of ours transferring because in today's economy when budgets are tight, patients cannot afford these out-of-pocket expenses. As a result, we are also losing business.

Despite my request to this health insurer to reconsider this, it is a two-year cycle before they will reconsider reinstating us.

As I see our president bashing the insurance companies and the CEOs who make millions of dollars at the expense of employees and even employers such as myself who are paying higher premiums for less benefit, it seems incongruous to me that this can happen. I have written and asked for assistance from several of our state legislators as well as to the insurance commissioner and I am still waiting to hear back, but I am not optimistic about their ability to help in any way.

I wonder, however, if patients or the upper-level administrators of these large companies pick their physician based on how cheap he or she was versus how well he took care of his patients, his complication rates and overall satisfaction of his patients and success of his or her surgeries. I doubt that anybody with some degree of intelligence is going to have their heart surgery, neurosurgery or any major surgery for that matter done based simply on how cheap one's services are (other than the insurance companies who want to pay as little as possible).

I believe that all businesses should look into the fact when they are signing contracts with insurers that their employees have a choice of physicians in all specialties in the town that they reside so that they don't have to leave town to find those specialists. I further believe that allowing insurance companies to decide participation based solely on cost is not in the patient's best interest. Why not consider training, complication rates, patient satisfaction and other quality indicators in their criteria.

Jay B. Greenberg, M.D., F.A.C.O.G., F.A.C.S.
Hagerstown




Paper didn't 'follow the money' during session



To the editor:

Shame on us tea partiers if we let The Herald-Mail define the fundamental debate about our next election. We have John League printing an editorial praising politicians who vote for increased spending and debt. We have Tim Rowland speaking eloquently about the virtues of politicians adding to Maryland's (and hence the taxpayers') debt burdens.

Does The Herald-Mail really expect us to ignore what has been going on for years and declare that this recently concluded state legislative session is the only one to be used as criterion for whom to elect?

Before this state legislative session began, I e-mailed Erin Julius, Jake Womer and Linda Duffield to "follow the money." Instead, they extolled the legislative records of a couple of local politicians. Did they cover the increased spending and debt from these people over the years? Did they show the impact of moving $140 million from the Chesapeake Bay Fund to the general operating expense budget, a move that mirrors the using of Social Security cash by D.C. politicians? Did they analyze and report on the budget reconciliation measures - again, by "following the money"?

Who among us would vote for politicians who announced outright that they would spend their way to influence with the local elites? Who among us believes that those same elites who push for using taxpayer money would get a majority vote if their projects were put on a local spending ballot?

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