By Tim Bonfield
The Cincinnati Enquirer

Three local physician groups have pulled out of United Healthcare networks over contract disputes in the past several weeks, leaving hundreds of patients faced with finding new doctors or paying more to see their current doctors at "out-of-network" rates.

Effective June 2, the University Ear Nose and Throat group will no longer participate in United networks, according to a letter sent to patients April 29. Similar changes took effect April 1 for Beacon Orthopaedics and Sportsmedicine and Wellington Orthopaedic and Sportsmedicine.

Aside from disrupting care for current patients of the groups, the pullouts will reduce the overall choice of physicians available to the 260,000 Tristate residents covered by United. In rare cases, patients requiring highly specialized care could find themselves leaving town for treatment.

When it comes to rare and complex surgery for cancers of the larynx and sinuses and other complicated reconstructive surgery, the specialists at University ENT often are the only experts in town.

"We do all the tertiary referral stuff for a radius of 100 miles. If these cases don't come to us, they'll have to go to Columbus, Indianapolis or Pittsburgh," said Dr. Jack Gluckman, president of the University ENT group. "Yet when we get the complicated cases, we have to fight tooth and nail (with United) for reimbursement at a particularly low rate. It's killing us."

On the orthopedic side, the Beacon and Wellington groups recently formed a new unit called New Millennium Orthopedics to share resources and jointly negotiate contracts with health plans. The doctors recently signed a contract with Anthem Blue Cross and Blue Shield, but United has refused to even acknowledge the New Millennium unit, said Steve Scheffel, administrator for the Beacon group.

Unless rates improve, these doctors say, they cannot afford to keep serving United members.

"In the past three years, our own employee health plan rates have gone up 45 percent (through Humana), but our reimbursement rates from United have gone up 3 percent. We've also seen a 200 percent increase in our malpractice rates in just one year," Scheffel said.

The University group estimates it will give up 10 percent of its patients to dump United. Beacon expects to lose 11 percent. The doctors say they don't want to turn away patients, but the frustrations are overwhelming.

"This puts physicians in an awkward position of saying, 'I'd love to treat you, but I can't,' " Scheffel said.

United, however, says some doctor groups - it won't say which ones - have asked for huge rate increases, some in the range of 30 percent to 40 percent. One Ohio group, not in Cincinnati, asked for a 75 percent increase.

"We believe in reasonable and justifiable reimbursement rates," said United spokesman Mike Strand. "There's pressure on everyone to reduce the costs of health care from consumers and from employers, and we follow that lead religiously."

Despite the pullouts, United's Greater Cincinnati network still includes about 85 orthopedic specialists and about 85 ear-nose-throat specialists, Strand said.

In addition, many United members can continue to see the University, Wellington or Beacon doctors if they are willing to pay out-of-network rates.

Out-of-network benefits, when available, can range widely depending on the employer involved. Some pay 70 to 80 percent, others 60 or even 50 percent.

While the United dispute has been especially pointed, Gluckman said the University group has found rising tensions in general between doctors and insurers.

"I've been in practice for 26 years. The anger and frustration is increasingly manifest now. There's an increasingly confrontational attitude on both sides," Gluckman said.

E-mail tbonfield@enquirer.com