Copyright © 2012 Albuquerque Journal
Thousands of Lovelace Health Plan members who receive medical care from ABQ Health Partners will either have to find new providers, change insurance companies or pay their bills out of their own pockets as of Nov. 9.
The companies said Tuesday they were unable to reach agreement on a new contract and agreed the sticking point was the medical group’s desire to adopt a coordinated care model for treating patients. That model would involve moving some functions traditionally performed by an insurance company to the medical provider.
Lovelace Health System CEO Ron Stern told the Journal the system’s health plan wasn’t convinced ABQ Health Partners was capable of handling those functions and questioned whether state insurance regulators would approve such an arrangement. He said Lovelace would like to pursue an agreement if the practice shows it can operate its model successfully.
ABQ Health Partners CEO Harry Magnes said the companies have been trying to work out a coordinated care agreement for years and that Lovelace was trying to protect its own financial position.
Both companies emphasized they will help plan members move to new health care providers if they choose to remain with Lovelace.