New Mexicans forced to choose between doctor, health insurance company

Posted at: 10/10/2012 6:13 PM
Updated at: 10/12/2012 11:15 AM
By: Chris Ramirez, KOB Eyewitness News 4

Tens of thousands of New Mexicans are being forced to make a tough medical decision; deciding between a doctor or their health insurance company.

ABQ Health Partners announced it is no longer accepting Lovelace Health Insurance plans.

According to both companies, they had been in contract negotiations for weeks until it broke down this week. The failure to reach an agreement is forcing patients like Charles Maycumber to make a decision he never wanted to make.

"I've known my doctor for too long and he knows my whole history,” Maycumber said. “I'm very happy with my primary care physician. He knows my whole history."

ABQ Health Partners provides a long list of medical services, and for the last five years, the company has been closely allied with Lovelace Health Insurance. In fact, about 50 percent of all ABQ Health Partner patients use Lovelace's insurance plans.

"The termination of the relationship by ABQ Health Partners on there part was unfortunate and disappointing," said Ron Stern, CEO and President of Lovelace Health System.

Stern pointed KOB Eyewitness News 4 to a class action lawsuit. It claims that the parent company of ABQ Health Partners is operating illegally as an HMO in California and is defrauding its patients. Stern said Lovelace asked for additional time to investigate the claims and that is when ABQ Health Partners ended the contract. ABQ Health Partners disputed Stern’s statements.

"I don't know what the merits are of that piece of paper,” said Dr. Aric Coffman of ABQ Health Partners. “(The lawsuit) certainly never came to our attention prior to today as this being an issue in our negotiation."

Meanwhile, while two large companies squabble over money and business, tens of thousands of people have to figure out how they will pay for their medical services and with who.

"To change to another physician at this stage, well I'm kind of old to be doing this kind of stuff,” Maycumber said.

Coffman said he encourages ABQ Health Partners to keep their current doctors and look for a different health insurance company.

Lovelace Members can contact the company in the following ways:
Members are welcome to contact Lovelace toll-free at 505-727-5555, Monday through Friday, 8 a.m. to 11 p.m., and 8 a.m. to 8 p.m. on Saturdays to identify a new provider, as well as set up an appointment if needed.

Members may also email Lovelace at findadoctor@lovelace.com and responses will be provided within one day.

Lovelace Health Plan’s Customer Care Center will also be open to answer members’ questions in person. The center will be open from 8 a.m. to 5 p.m., Monday through Friday, and is located at Lovelace Health Plan, 4101 Indian School Road NE, in Albuquerque.

Those with questions about Medicare and the Medicare Advantage health plan can contact the Centers for Medicare and Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit the CMS website at www.medicare.gov. TTY users, please call 1-877-486-2048. CMS can be reached 24 hours a day, seven days a week.