Insurance company and Mary Washington Hospital's emergency-room doctors are being asked to resolve their differences.

By JIM HALL

Date published: 12/15/2004

Pressure is being applied to both Anthem and the emergency-room doctors at Mary Washington Hospital to settle their health-insurance impasse.

The pressure has come from sources as varied as local personnel directors, the hospital administration and Rep. Jo Ann Davis.

The message has been a consistent one: Keep talking. Find a compromise solution.

The pressure is a measure of the critical role played by the emergency room doctors for Anthem's 56,000 local customers.

"I have heard from a number of my constituents who are very concerned with this and how it will impact their families," Davis, R-1st District, wrote in a letter to Anthem last week. "I hope you will do all in your power to resume talks with [the doctors] to find a workable solution."

The dispute pits the state's largest health-insurance company against the 23 doctors and physician assistants who work for the Fredericksburg Emergency Medical Alliance, the private company that staffs Mary Washington's emergency room.

The doctors told Anthem that its payments were too low and that they plan to withdraw from Anthem's network on Dec. 31.

If a breach occurs, it means that area residents who are insured by Anthem will pay more whenever they visit the Fredericksburg emergency room.

The ER doctors would be considered out-of-network providers. Patients could still go to the ER, and Anthem will continue to reimburse for their services, but it will send the money directly to patients. The patients will have to pay the doctors and make up the difference between what Anthem pays and what the doctors bill.

Mary Washington Hospital is an interested observer but not a party to the dispute. The hospital and all of its divisions, including all other services in the ER, are still part of the Anthem network.

"[The doctors] are free to negotiate their contract with their providers," said Walter Kiwall, the hospital's chief operating officer. "We expect both parties to negotiate in good faith, but we do not require them to participate in all the plans that we participate in."

Kiwall said the hospital has encouraged both parties to find some middle ground.

"We're confident that that ultimately will happen. It usually does," Kiwall said.

Date published: 12/15/2004