ANNAPOLIS – From 1988 through early 1994, Dr. Francine Higgs- Shipman was satisfied with her arrangement with the health maintenance organization insuring many of her patients.
But in June 1994, the black physician with Baltimore City and Howard County practices received a letter from the HMO saying her services were no longer needed in that geographic area, she testified before a House committee Thursday.
Meanwhile, an Asian doctor up the street told Higgs-Shipman that the same HMO had enlisted her and promised patients.
Higgs-Shipman said she couldn’t get a satisfactory explanation of her dismissal from the HMO.
She told her story before the Economics Matters Committee, which is considering a bill intended to hold HMOs and other managed care plans accountable for under-enrollment of black doctors.
Under the bill, sponsored by Del. Joanne Benson, D-Prince George’s, the Department of Health and Mental Hygiene and the Maryland Insurance Administration would specify that doctors in Higgs-Shipman’s position have the right to a thorough appeal and explanation of decisions.
The measure is similar to the 1995 Patient Access Act, which took effect Oct. 1. But black doctors and others say insurers continue to neglect the issue, even as the state looks to enroll thousands of Medicaid recipients in managed care.
“The patient access bill has failed,” Dr. Lenox Dingle, a general surgeon in Baltimore, told the committee. “We predicted from day one that this would happen.”
The current situation is “tantamount to taxpayer-funded, state- endorsed discrimination” by an HMO industry “in a real state of denial,” Dingle said. “We’re having our businesses taken away from us.”
Dingle is president of the Greater Maryland Coalition for Health Assurance, an advocacy group for black doctors and their patients. He said his organization found only 11 black doctors among 225 enrolled with one Baltimore managed care organization.
But a spokeswoman for the trade group representing the 20 Maryland HMOs denied that a problem exists.
“We do not believe that we discriminate … based on race,” said Martha Roach, executive director of the Maryland Association of Health Maintenance Organizations.
The bill would unduly interfere with HMOs’ selection of doctors and adversely affect the cost and quality of health care, Roach said.
Roach said the Patient Access Act was sufficient, and added that plans were under way to meet with Dingle and others to resolve the issue outside of government.
Baltimore City Council President Lawrence A. Bell III testified in favor of the bill, saying that fairness and practicality were reasons for passage. African-Americans “are finding they are not able to practice in the communities they come from,” he said. “It is simply wrong to have health panels that don’t reflect the racial demographics of the state.” -30-