Dear Patient,

As medical director of Choices West, a Center for Women’s Health, I am lodging a complaint against Excellus BC/BS of CNY to the NYS Insurance Commission, the Medical Society of NYS, the NYS Depart of Health, and to our local senators. My complaint is based on recent notification by Excellus that they have decided not to renew my provider agreement on 1/01/09. I believe that their decision to terminate our agreement is a form of retaliation for an ongoing law suit between Choices West and Excellus, in which, Excellus has been trying to recover funds from a 6/2000 Univera audit. According to Univera, (now Excellus) the results of the audit indicated a substantial overpayment to Choices West. It is important to note, the audit included coding, medical necessity, and documentation issues; quality of care was never an issue.

I adamantly disagreed with Univera’s audit results, and hired a certified coder from an independent company, who confirmed that the Univera audit was flawed. Univera/Excellus has performed these same types of audits on numerous Physician practices in our community, and in all cases an overpayment was determined. According to my colleagues, they all paid either the amount of overpayment determined by Univera/Excellus, or a negotiated reduced amount. I have continued to refuse to pay Univera/Excellus based on principle and my belief that the audit was not correct. I have had past, as well as recent audits by other insurance carriers, who have found no issues with coding, medical necessity, or documentation. I have spent thousand of dollars in defending my practice, and will at this juncture, allow the courts to decide who is right. Excellus recently notified me that they have decided to terminate our professional provider agreement “without cause.” I believe this recent notice by Excellus is an attempt to intimidate Choices West and impose yet another financial hardship on the practice, when in reality the hardship is being imposed on their members, who will now have to pay upfront for services at the time of their Choices West visit, and get reimbursed directly from Excellus.

For the record, I would like to inform you that Choices West has been providing high quality care for women for almost twenty five years. Choices West has served as primary care providers for thousands of women, and provided fertility treatment to hundreds more. We have provided obstetrical care and have performed over ten-thousand deliveries over the past twenty five years. We have one of the lowest Caesarean Section rates in New York State, and possibly the United States. I have performed thousands of surgeries for women with a very low rate of complications, and have been recognized as one of the top OB/GYN physicians in the country. Choices West has a very high patient satisfaction rate.

Excellus’s decision not to contract with health care leaders in their community is a major disservice to their members. This total disregard of their members’ interest negates the mission of the organization, that is, to provide high quality of care to its members. Although Excellus is a non-profit organization, as established by the New York State Insurance Department, their mission and their financial interest appear to be in direct conflict.

I request a full investigation, and an answer from Excellus to the following questions: If there is “no cause” for termination, why did they make the decision to do so? How many other health care providers have they terminated without cause?

If Excellus is allowed to terminate affiliation with physicians who perform high quality of care without cause, what kind of care will their members, who pay higher premiums each and every year, receive? From Excellus’s action, it appears that their interest lies in their financial return, which allows them to continue to provide bonuses and yearly salary increases to their top executives.

It is a dismal reality that if Excellus’s actions are not investigated and questioned, it will impact the quality of care its members receive in this community.

As Excellus will not notify their members of their decision to terminate our provider agreement, and have left this burden with our practice, I feel it is important for my patients to be informed. I am therefore sending a copy of this letter to all of my Excellus patients.

Sincerely,

 

M. Robert Neulander, M.D., F.A.C.O.G.