Payment for Epidurals

As obstetric anesthesiologists practicing at St. Mary Medical Center in Long Beach, we were mortified and embarrassed by the reprehensible policy to deny epidurals to Medi-Cal patients without a cash payment when these patients are completely vulnerable (June 14). We have always provided this service on demand regardless of the type of insurance the patient has and will continue to do so.

However, we think the Medi-Cal administration and public also need to know that many HMOs are guilty of this same offense. We have had denial of payment by some Medi-Cal HMOs for their enrollees having labor epidurals because the HMO, not Medi-Cal, deemed them not “medically necessary.” This policy is not just limited to poor women, but to many unsuspecting HMO patients regardless of their financial status.

Medi-Cal should expand its investigation to include all of the HMOs that they have aggressively funneled these patients into, for possible similar violations.

SUSAN SHERIDAN MD

JILL BOYLE MD

Long Beach

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I am a retired anesthesiologist. My retirement was hastened by my refusal to work for Medi-Cal fees--currently less than 25% of normal fees. Recently an anesthesiologist has come in for criticism for refusing to provide an epidural anesthetic to a Medi-Cal patient and demanding a cash payment. The state believes that doctors should be forced to work for state-dictated Medi-Cal fees. Shouldn’t it also demand that all merchants and professionals be forced to accept payments of 25% of normal?

Why didn’t the obstetrician explain the situation at the hospital and have the patient bring the requisite fee when she came to the hospital?

ROBERT S. ELLYN MD

Calabasas