Aug. 12--Nearly 50 Colorado Springs doctors are dropping out of PacifiCare's Secure Horizons Medicare program following a July notice that Secure Horizons patients no longer would be treated at Memorial Hospital.
The news affects about 828 of the doctors' patients, who will have to find new doctors or switch insurance plans.
PacifiCare will notify the patients by mail.
PacifiCare is Colorado's largest health insurer. Secure Horizons is the plan it offers to senior citizens.
Effective Sept. 1, Secure Horizons' 16,251 El Paso County members will have to use Centura Health's three area hospitals -- Penrose Community, Penrose Hospital or St. Francis Health Center.
About 7,000 members who had used Memorial received letters in July informing them that the hospital no longer would be an option for them.
PacifiCare surveyed 240 Springs physicians in July about moving their Secure Horizons patients to Centura. PacifiCare reports that 48 doctors -- two primary care physicians and 46 specialists -- said they would rather end their participation in Secure Horizons.
'Only 828 members out of 16,251 will be affected,' said PacifiCare spokeswoman Janet Reese. 'We have sent letters to these members indicating their doctor is leaving.'
One primary care physician who dropped out of Secure Horizons is internist Dr. Andrew Ellias. On July 21, Ellias sent a letter to 300 of his patients telling them he could no longer do business with Secure Horizons.
Although he has doctor privileges at Centura, he said he prefers Memorial.
'The choice I had was to either comply with this decision or no longer participate in the care of Secure Horizons patients,' Ellias said. 'Once again, we are just all impersonal pieces in a profit-driven system. I am tired of everyone telling me what I can and cannot do in the care of my patients.'
Ellias' patients can choose another doctor in the Secure Horizons directory or switch to another health plan, including Medicare, which Ellias accepts.
But Medicare does not pay for prescriptions, which is why many seniors use Medicare HMO plans.
Two other HMOs offer Medicare programs in El Paso County, the Department of Defense's TRICARE and Rocky Mountain HMO. Ellias accepts Rocky Mountain HMO members, but because of open enrollment laws, Secure Horizons members cannot receive Rocky Mountain prescription coverage until Jan. 1.
Rocky Mountain's Gold Plan, which covers prescriptions, will have an open enrollment period later this year, pending federal approval.
Four of the 46 specialists opting out of Secure Horizons are the cardiologists at the Heart Center of Colorado. Like Ellias, the Heart Center sent its Secure Horizons patients a letter about the Sept. 1 change. Between 75 and 100 patients were notified, said L.D. Jacobson, Heart Center's chief financial officer.
Jacobson said the physicians did not think they could provide the kind of care they wanted without Memorial.
He said senior plans like Secure Horizons are doomed because they try to cover more expenses with less money than straight Medicare pays. 'These plans appeal to patients who are very ill and need a lot of care,' Jacobson said. 'I believe this is a prelude to PacifiCare pulling out of all of southern Colorado.'
Heart Center patients can seek a different Secure Horizons cardiologist, seek a different Medicare HMO or switch to Medicare. Three of the four Heart Center doctors also participate in the Rocky Mountain HMO.
State Medicare officials were not aware of the Memorial-related doctor terminations, but will be watching to make sure PacifiCare can adequately treat its Medicare members. 'We want to know if they have enough physicians and specialists to handle the needs of the members,' said state Program Coordinator Penny Finnegan. 'Our staff is monitoring the situation to make sure the members are being taken care of.'
To see more of The Gazette, or to subscribe to the newspaper, go to http://www.gazette.com
(c) 2000, The Gazette, Colorado Springs, Colo. Distributed by Knight Ridder/Tribune Business News.
