Berkeley Parents Network: Pediatricians, New Patients and HMOs

Berkeley Parents Network

Pediatricians, New Patients and HMOs

Berkeley Parents Network > Reviews > Insurance > Pediatricians, New Patients and HMOs

Pediatric groups not accepting new HMO patients (1997)

Pediatric groups not taking Blue Cross (2004)

Pediatric groups not accepting new HMO patients

December 1997

I am expecting my first child in early April, and have recently started the hunt for a pediatrician. I am a professor here at UCB and have been using Health Net as my health care provider since 1993. I also, ironically, grew up in Berkeley, and thus my first choice of a pediatrics group was the one my mother chose for me: Berkeley Pediatrics. My second choice was East Bay Pediatrics, which has also come highly recommended from multiple sources. Thus, you can imagine my great dismay when I called each of these groups and learned that they are not accepting new HMO patients. At the present time, in fact, there are only 3 pediatricians (none of whom have group practices) that are accepting new HMO patients in Berkeley.

Apparently a dispute is occurring between the HMO's and pediatricians in particular. The dispute seems to involve, unsurprisingly, the lack of satisfactory payment to doctors for treating HMO patients. Negotiations are ongoing, but no one is willing to predict the outcome of this sad state of affairs.

I am writing to let those of you who will be looking for a pediatrician know that this situation exists, and to urge any of you who belong to HMO's to voice your concern about this situation. My OB-GYN believes that pediatricians are being very poorly treated by the HMO's and that this situation may escalate and even affect existing patients. Perhaps added pressure from HMO patients (I suppose they call us "customers") will provide additional incentives to settle this matter and provide the level of choice that the HMO's had previously promised. I will not hesitate to quit Health Net and pay more and join a PPO in order to be able to use the pediatrician of my choice. Of course, this will involve the inevitable HMO-type hassles, such as the open enrollment window (Nov. for UC employees) being closed.

If anyone has any more information than this small amount I have gathered, or any sage advice, I would be most grateful! Jenny

Note: UC Bencom administers medical plans for university employees.

UC Bencom web page: http://www.ucop.edu/bencom
UC Bencom Customer Service: 1-800-888-8267 (9-4 M-F)

The above web page also lists phone numbers for all the medical plans at: http://www.ucop.edu/bencom/info/hw.html

To the poster who was having trouble finding a pediatrician covered through the Berkeley HMO's: I was at East Bay Pediatrics the other day and apparently negotiations have progressed, though they are still not accepting new patients. They thought it was a thirty day thing originally, but it's been four months. Myrium

It was mentioned a few weeks (months?) ago that the BPMG was not accepting any new HMO patients. I just had my prenatal interview with our wonderful Ped. there, Dr. Howard Gruber, and thought I'd post an update. They are still not accepting new HMO patients, but if you have an older child who is currently a patient they will take any new siblings that come along. The reason for the trouble is that ABMG is refusing to compensate them at a level sufficient to even cover their overhead. So, the more HMO patients they see, the more money they lose.... Unfortunately, it sounds like this could go on for a long time. Lee

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