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.
A group of local human resource directors delivered a similar message when they met with Dr. Drew Garvie, FEMA's president, last Friday. The group represented about 8,000 local government workers from Spotsylvania, Stafford, Fredericksburg and Caroline and public-school teachers from Spotsylvania and Stafford counties.
"We need to end this in a good situation for our employees," said Christine Campbell, Spotsylvania County's human resources director. "We're concerned about the cost for our employees."
The University of Mary Washington notified its workers of the dispute yesterday. It included in its e-mail the addresses and hours of local urgent-care centers that are Anthem providers. Anthem insures many of the university's workers.
Disputes between Anthem and hospital-based physician groups have occurred in Richmond, Fairfax and Tidewater, said Paul Kitchen, executive vice president of the Medical Society of Virginia.
In Roanoke, the area's only hospital-based anesthesiology group split with Anthem in March over what it called unacceptably low payments. The group returned to the Anthem network about a month later.
"Physicians and payers are constantly in this dance about compensation," Kitchen said.
Insurance companies push doctors for lower payments to please their stockholders and the customers who buy their policies.
Doctors, squeezed by rising costs, seek more money from the insurance companies.
It is not unusual for providers to walk away from an insurance network. Patients are then free to choose another doctor from among the network's providers. In this case, however, FEMA is the only doctor group working within the emergency room.
"Being hospital-based creates a different dynamic," Kitchen said.
Efforts to reach Garvie, FEMA president, were unsuccessful yesterday and Monday.
In a newspaper ad in Sunday's Free Lance-Star, he criticized Anthem's "unusually low reimbursement rates." He also said that Anthem has a "take it, or leave it" approach to negotiations.
"Anthem has been the only insurance company to give us an ultimatum and break-off negotiations," the ad states.
Anthem disputes that contention.
"We didn't break off negotiations," said Brooke Taylor, Anthem spokeswoman. "We have an offer on the table to continue discussions. We are very interested in getting an agreement."
Anthem says that FEMA is asking for new rates that are nearly double the standard fees.
"To agree to such an increase would raise their reimbursement to a level significantly higher than other ER physicians throughout Virginia," Anthem said, in a letter to its group administrators.
Specific reimbursement numbers are hard to come by. The Virginia Bureau of Insurance does not require insurance companies to file payment schedules with the state. Those rates are the result of private negotiations between the companies and their providers, said Kenneth J. Schrad, department spokesman.
"We just don't talk about prices at all," Taylor added.
Anthem's customers are likely to pay more no matter how the impasse is resolved. If the two sides fail to reach an agreement, and the ER physicians withdraw from the network, patients will be "balance-billed" by the doctors.
On the other hand, an agreement likely will mean higher premiums for Anthem's customers.
In the meantime, Deborah J. Holt is telling her customers to sit tight. Holt, the owner of Holt & Johnson Insurance Agency in Fredericksburg, represents a number of small businesses who offer Anthem health insurance to their workers.
"I'm not telling my clients to move," she said. "I'm not going to tell my clients to move until we see what happens."
Staff librarian Craig Schulin contributed to this story.
To reach JIM HALL: 540/374-5433 jhall@freelancestar.com