News 2003

Health Plan Changes for 2003

We do not expect any changes in the number of health plans we accept other than the addition of United Healthcare (started March 2002). While there is always turmoil in the marketplace, we have made a conscious effort to promote stability in our relationships with plans via multi-year agreements and regular ongoing discussions regarding issues. The major plans we are contracted with include the following:

• Aetna
• CIGNA
• Blue Cross (Anthem and New England)
• HMO Blue (Blue Cross of MA)
• Mathew Thornton
• Harvard Pilgrim
• Tufts
• HCVM- Includes other insurers who utilize this network
• PHCS- Includes other insurers who utilize this network
• United
• UNICARE

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Benefit Design Changes

It is no secret that insurance costs are rising - 15-22% on average for 2003. Many plans have also changed their benefit designs to include higher copays, co-insurance, and deductibles on services performed in the hospital. Patients of Derry Medical Center and Londonderry Family Practice save "out of pocket" costs by having Radiology and Cardiology services performed in our offices since these deductibles and copays usually apply to hospital inpatient and outpatient charges versus services provided in a physician's office. It will not be uncommon for patients to have to pay the first $500 for an outpatient service when it is not provided in a physician's office for many plans in 2003. Talk to our provider or your specialist and understand your coverage before choosing a location. You may be surprised at the services not covered on a first dollar basis.

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Specialty Care Network Issues

With the large number of patients switching plans in the last year (40%), many issues have arisen regarding specialty care affiliations. Many former Tufts and Harvard patients were accustomed to seeking specialty care in Boston teaching facilities. When many patients switched to NH based plans such as Anthem and CIGNA, it resulted in changes of participating specialty networks. Before making these choices, you should check to see if the specialists you are currently receiving treatment from are in your plan's network as a contracted provider. Harvard , Tufts, and HMO Blue the have the most robust network of specialists in Boston since they are Massachussetts based plans. Anthem and CIGNA have relationships with Boston hospitals for specialty care, however many of the physician specialists are not in their networks. Any "out of network" referrals may have to be approved by the health plan prior to receiving treatment.

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