Care Sought for Patients Mired in HMO Disputes

Contending that as many as 800,000 Californians face disruptions in their health care, Gov. Gray Davis on Tuesday renewed his call for legislation to ensure that patients’ coverage continues when their doctors and health maintenance organizations have contract disputes.

Daniel Zingale, head of the Department of Managed Health Care, said one such contract dispute in the Sacramento area threatens to disrupt care for 250,000 patients after Dec. 31, when an agreement between Sutter Health Care and HealthNet expires. Similar events could disrupt coverage for patients in San Diego and Santa Clara counties, Zingale said.

“The Sutter-HealthNet [dispute] is a situation that certainly got my attention,” Zingale said, explaining the timing of his news conference and a letter from Davis to legislative leaders.

In the letter, Davis said passage of legislation is imperative to ensure continuity of care for patients. Davis urged that lawmakers approve legislation when they reconvene in January.

“By working together again to put patients first, we can further strengthen and expand the right to uninterrupted access to health care,” Davis’ letter states.

Efforts to approve bills by Sen. Jackie Speier (D-Hillsborough) and Assembly Health Committee Chairwoman Helen Thomson (D-Davis) stalled in the final week of the legislative session in September.

Currently, patients in the final months of pregnancy or who are undergoing treatment for serious illnesses such as cancer or AIDS can continue to see their doctors. Patients with less urgent conditions, however, are forced to find new physicians.

Much of the Davis administration proposal is embodied in Thomson’s bill. The administration contends that physicians should be required to continue providing care for as long as a year during such disputes. It remains to be determined, however, how doctors would be paid during that year when they have no contract.

Among the suggestions: Health insurance companies would pay them at old rates for up to a year, plus an increase based on medical cost inflation.

“We will [resolve it], but it is not a simple ‘just do it’; it is complex,” Speier said.