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The termination of the health insurance contract between ABQ Health Partners and Lovelace Health System forced thousands of patients, some of whom are UNM employees, to switch health care providers, or pay their health care costs out-of-pocket, in less than one month.
UNM employees who choose to purchase health insurance through the University have the option to purchase a Presbyterian or Lovelace plan.
ABQ HP is a network of 184 independent physicians that has been closely affiliated with Lovelace and formerly contracted with LHS to accept Lovelace health insurance.
Lovelace CEO and President Ron Stern said at a meeting Tuesday that LHS received a letter last week from ABQ HP that terminates LHS’ contract, effective Nov. 8. He said LHS had a five-year contract with ABQ HP and that attempts to negotiate a new five-year contract were ineffective.
Stern said ABQ HP submitted the contract and that, because he did not feel the contract was appropriate for LHS to sign, he requested additional time for the contract to be reviewed by the superintendent from the department of insurance to ensure it made sense. He said ABQ HP representatives gave LHS one week to review the contract but that the time span was insufficient to ensure it was properly reviewed, so the Nov. 8 termination date remained in place.
“They gave us a proposal that didn’t make sense, not for economic reasons but the way they wanted to structure the agreement. We need some time to make sure it makes sense,” he said. “I’m not going to sign any agreement that I don’t think is in the best interest of you and all the health plan’s members we serve and the hospitals and all of our patients.”
Stern said that after the meeting with ABQ HP, LHS learned that the company was sold to Healthcare Partners, a company in California, in September. He said he requested to speak with representatives from California, but that conversations with company representatives did not make a difference.
“We said ‘Well, let’s get those people from California and sit down and talk with them, maybe they’ve got it figured out and they’ll solve the problem,’” he said. “Well it didn’t quite work that way, they stood firm and said here’s the deal take it or leave it … so I said ‘We’d rather lose health plan members than sign a bad deal.’”
Stern said LHS will continue to hold meetings to help transfer members to new doctors and that members can call LHS or visit the LHS center for assistance. He said that despite the conflict with ABQ HP, other doctors and medical practices in the area, such as New Mexico Orthopedics and the New Mexico Heart Institute, have supported LHS.
“We’re going to do everything we can to make sure you get a great doctor, and if you don’t like the first one, we’ll give you a second and if you don’t like the second, we’ll give you a third,” he said. “As this process began, we’ve been very surprised by the medical community at large … we’ve had doctors who said they’re standing up for Lovelace. We’ve had overwhelming support.”
But Stern said LHS needs to open additional urgent care facilities and will look into facilities in Rio Rancho and Albuquerque. He said patients who visit urgent care facilities for immediate health care can use Lovelace hospital emergency room facilities at no additional cost during the transition period.
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Stern said LHS filed a lawsuit against ABQ HP because ABQ HP has exhibited illegal practices regarding relations with Medicare beneficiaries.
According to an article in the Albuquerque Journal, ABQ HP breached its contract with LHS by soliciting LHS members to utilize other insurance companies, interfering with business between LHS and its customers and violating state and federal regulations that govern marketing to Lovelace’s Medicare Advantage plan customers.
“We’ve asked the courts to give us some relief on that issue,” Stern said.
Lovelace Chief Programs Officer Marlene Baca said that although some Lovelace Health Plan members were told by ABQ HP representatives that patients can continue to see ABQ HP doctors until December, Lovelace will adhere to the contract termination date, which is Nov. 8. She said that, should a patient continue to go to ABQ HP, he or she should request that ABQ HP put in writing that its providers will continue to see Lovelace members until the end of the year.
“There’s a lot of confusion around the November 8th and December 31st dates … because we have a contract, we’re following with the termination date of November 8th,” she said. “The decision that ABQ Health Partners is making about seeing patients through the end of the year, that’s their decision, and we don’t really know how they’re going to do that.”
But Baca said current UNM employees and retirees can continue to see doctors at the UNM Sandoval Regional Medical Center. She said the contract with UNM SRMC has not been terminated.
Following a meeting with the New Mexico Superintendent of Insurance John Franchini, ABQ HP and LHS representatives agreed to a special plan that will allow some patients to not experience a gap in health care.
Franchini said that at a meeting with ABQ HP and LHS, representatives shared a transitional care plan that will allow about 3,000 Lovelace Health Plan members to continue to see their doctors at ABQ HP. He said members who are currently receiving health care for certain medical problems, including cancer treatment, care for serious diseases and planned or recent surgery, will not experience a gap in coverage.
Franchini said that under the transitional care plan, women who are pregnant can continue to see their obstetric and gynecological doctors until six weeks after they give birth for postpartum care.
He said members who use the plan will not experience an increase in out-of-pocket costs.
