Atwater Medical Group loses patients due to closing of local HMO network

The closing of a local HMO network has left about 200 Atwater Medical Group patients with new doctors and some unanswered questions.

Blue Shield decided to close its Merced Direct Contract HMO, a network that had been around since 2003 serving mainly active and retired public employees.

The network had contracted with Atwater Medical Group for several years, according to the medical group’s office staff. However, with the disbanding of Merced Direct Contract HMO, patients were switched to doctors that are part of the AllCare Independent Physicians Association.

Sean Barry, a Blue Shield spokesman, said the decision to close Merced Direct Contract HMO and transfer members to AllCare IPA was made to help Blue Shield manage its growing HMO membership in the Merced area.

Merced Direct Contract HMO served about 2,000 people in Merced County, but the majority of members did not need to change their doctors because most doctors available through the network either already had a contract with AllCare IPA or newly contracted with it, Barry explained.

In an email response to the Sun-Star, Barry wrote that Blue Shield sent notices back in September to all affected physicians, including those with Atwater Medical Group, to let them know about the developments. The notice encouraged Atwater Medical Group to become a participating provider with AllCare IPA so its patients could keep their same doctors, according to Barry.

“We understand that AllCare also sent letters to these providers with a similar message,” Barry wrote.

But some Atwater Group physicians declined to join AllCare IPA, he added.

Cory Ross, family practice and urgent care office manager at Atwater Medical Group, said the office and its physicians never received those notices. “We never got a notification from Blue Shield,” she said. “Patients started calling us with questions and complaints; that’s how we found out.”

Ross explained that she found out about the termination of Merced Direct Contract HMO during the holiday season. She said office staff has been in contact with Blue Shield representatives, but has not received a concrete answer as to why the contract network was shut down and why their office didn’t receive the notifications.

“Some of our patients are so angry at us, but it wasn’t us; this is not something we wanted,” Ross said. “We’re losing a lot of patients, which we do not want to lose.”

Because several patients have shown up to the medical group’s office unaware of the recent changes, Ross believes some patients may not have been notified either.

Jeff Bray, 51, found out that he had been assigned to a new doctor at another medical group when he went in for a scheduled appointment last week. He was told by the front desk that he had been assigned to an AllCare physician at Castle Family Health Centers, he said.

“I showed up (to Atwater Medical Group) and they told me that I had to pay cash if I wanted to see my doctor,” Bray said.

Bray, a retired state correctional counselor, said he’s seen Dr. Joerg Schuller at Atwater Medical Group for more than a decade. He said he never received any type of notification about the changes.

“I hadn’t heard a word,” Bray said. “Believe me, if I had known, I would’ve enrolled in a plan that kept me with the same doctor.”

Because the window to make any changes in his health plan has closed, Bray said he is not being given the option to move to a different health plan that would allow him to continue seeing Schuller. Bray said he is on three different medications and feels comfortable only with a doctor that knows all his medical history.

“It would be like starting all over,” he said. “All of this has been a nightmare.”

But according to Blue Shield, notification letters were sent out to all affected members.

In his email response, Barry wrote that members that were moved to new physicians with AllCare should have received letters to alert them of the change at least 30 days prior to the effective transition date.

He also added that Blue Shield’s records show that affected members who were with Atwater Medical Group were moved to an AllCare primary care doctor within 10 miles of the Atwater Medical Group facility for members’ convenience.

Members with questions can call Blue Shield at (800) 424-6521 or Atwater Medical Group at (209) 358-5611.

This story was originally published January 20, 2015 at 9:14 PM with the headline "Atwater Medical Group loses patients due to closing of local HMO network."