From: keg@strathspey.llnl.gov (Keith Grant)
Newsgroups: ca.general,ba.general
Subject: Health Plans - Foundation
Date: 6 Apr 92 20:50:37 GMT
Reply-To: keg@strathspey.llnl.gov (Keith Grant)
Followup-To: ca.general
Organization: Lawrence Livermore National Laboratory


Summary:

In the several paragraphs following I describe a change in the 
Foundation Health Plan referral process that I feel has a significant 
negative impact on the health consumer.  I site a couple of examples 
of this impact and urge people to complain to Foundation and their 
benefits coordinators.  I also provide a list of addresses and phone 
numbers.  I STRONGLY SUSPECT THAT THE CHANGES I DESCRIBE MAY BE AN 
EMERGING TREND FOR THE HEALTH CARE PROVISION INDUSTRY IN GENERAL.  
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Recently (and after my annual open enrollment period), Foundation 
Health Plan has announced a change to the way they do business.  At 
least in Sacramento and Tri-valley areas (Livermore-Pleasanton-San 
Ramon) they have established new restrictions on specialty referrals.

The basic difference is the establishment of multiple physician
groups within single geographic areas.  Under the new set-up, your
principal care physician (PCP) can refer you to specialists
(allergests, OB/GYNs, cardiologist, opthamologists, ...) only within
his own medical group.  I have also heard (but can't absolutely verify)
that physicians have been pressured to belong to only one group.  IN
EFFECT, THIS AMOUNTS TO SETTING UP A TURF WAR BETWEEN COMPETING
PHYSICIANS GROUPS WITH THE HEALTH CARE CONSUMER BEING THE ULTIMATE
LOSER.

Foundation has stated in a recent news letter that this change
will insure that "... you will normally be referred to specialists
within that same group--specialists that your PCP knows and trusts".
In my opinion, this is a rather trite gloss-over of a change they
find to be administratively expedient.  What it means to the health
plan consumer is a substantial loss of choice.


For example, a friend of mine recently discovered this change, not
by advance written notice from FOUNDATION, but by a note in her
OB/GYN's office to the effect that in the near future referals could
no longer be accepted from her PCP.  The choice that was presented to
her was to either change her OB/GYN or her PCP.  Her PCP was one that
she was happy with and had established a good relationship with over
several years.  Her OB/GYN was also one that she was happy with and
under prenatal care with.  I certainly find this incident to be an
absolutely infuriating illustration of Foundations lack of concern
for their customers.

In my own case, I had to choose a new PCP because my old doctor was
retiring.  After choosing another doctor in the same office, I
discovered (only after receiving my new membership card) that the
office had switched medical groups.  I was now on the opposite side
of the "fence" from where I had been and had to choose yet another
PCP to get back.  Ugh!  Meanwhile, I'm waiting for all the paperwork
to get processed so that I can see my new PCP and get a new referral
to my allergist.


If you have had similar recent experiences and feel inclined to
comment I would urge you to send a letter to Foundation's corporate
headquarters with copies to your benefits coordinator and individual 
medical groups.  My goals include motivating Foundation to find a 
more customer considerate means of organizing their coverage and 
insuring my coordinator is aware of customer dissatisfaction.  I 
have included a list of addresses and phone numbers that may be 
helpful.  The Pacific Health Care and Hill Physicians medical groups 
are specific to the Tri-Valley area.  I have strongly complained by 
phone to Foundation and am in the process of drafting my own letters 
of complaint regarding their referral policy.  Since I also believe 
that turf wars between medical groups may be a more general health 
industry problem, I've listed several California legislative
addresses as well as those of regulatory departments and physicians
lobbying groups. I would also urge you to write letters to the
editors of newspapers in your area.  Thanks a bunch and good luck.

Keith Grant

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Foundation Health Corporation
3400 Data Drive
Rancho Cordova, CA 95670
916-631-5000

Executives:
   Daniel Crowley:   Chm Bd, Pres, & Chief Exec Officer
   Jeffrey L Elder:  Sr VP & Chef Financial Officer
   Kirk A Benson:    VP & General Counsel
   Scott Kelley:     VP-Marketing
   Annette Wimmer:   VP-Sales
   Joseph Linger:    VP & Chief Admin Officer

Board of Directors:
   Crowley, Daniel D
   Anderson, Robert
   Boggs, David A.
   Elder, Jeffrey L.
   Fowler, Earl B.
   Halloran, Michael J.
   Hanselman, Richard W.
   Jeske, Howard L.
   Tough, Steven D.
   Troubh, Raymond S.

Selected Affilitates (Wholly owned by Foundation Health Corporation):

Foundation Health a California Health Plan
(same address & phone #)
  Steven D Tough:  President

Foundation Health Preferred Administrators
(same address & phone #)

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Hill Physicians Medical Group
Steve McDermott, Administrator
2401 Crow Canyon Rd #130
San Ramon CA 94583
510-820-8300
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Pacific Health Care Medical Group
Hal Sadowy, Chief Executive Officer
6000 Stoneridge Mall Road, Suite 290
Pleasanton, CA 94588
510-463-0655, FAX 510-463-0530
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Additional Addresses that may be useful for more general input on
health care management practices and your opinions about them:

State Senate:
(name of State Senator)
Box 942848
Sacramento CA 94248-0001

State Assembly:
(name of Assembly person)
Box 942849
Sacramento CA 94249-0001

   In particular, a recent California legislature guidebook lists
   William Filante, R-San Rafael, Assembly District 9
   as the only physician on the assembly and one interested in
   health care and its provision.  His district office can be
   reached at (415) 479-4920

California Medical Association
925 'L' St
Sacramento CA 95814
(916) 444-5532

American Medical Association
515 N State ST
Chicago IL 60610-4377
(312) 464-5000
James S. Todd, Exec VP

California Dept. of Consumer Affairs
1020 'N' St
Sacramento CA 95814
(916) 445-4465

California Board of Medical Quality Assurance
1430 Howe Avenue
Sacramento CA 95825
(916) 920-6393

California Dept of Insurance
100 Van Ness Avenue, 17th Floor
San Francisco CA 94102
(415) 557-1126


  +-------------------------+-----------------------------------------------+
  I                         I                                               I
  I Keith Eric Grant        I The interesting thing about a waltzing bear   I
  I keg@strathspey.llnl.gov I           is not how well it dances!          I
  I                         I                                               I
  +-------------------------+-----------------------------------------------+
  I                                                                         I
  I For certain it is, that any ideas expressed above are of my own humble  I
  I opinion and bear nary a relation to the policies or positions of LLNL   I
  I or of any agency or contractor of the U.S. Government.                  I
  I                                                                         I
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Newsgroups: ca.general