Dr. Lisa Haworth talks with a patient Wednesday about her decision to no longer accept Blue Cross Blue Shield insurance beginning June 1. The company told about 2,000 physicians and specialists it will cut its reimbursement for some 50 services. Photo by Clint Karlsen.

Signs in Dr. Lisa Haworth's office on Wednesday delivered bad news for about 1,400 of her patients: "As of June 1, 2006, we will no longer accept Blue Cross Blue Shield."

The company recently informed Haworth and 2,000 other physicians and specialists in its Nevada provider network that it will lower by as much as one-half what it reimburses them for some 50 services, such as consultations and office visits. The new rates take effect June 1.

In some cases, the company's rates will fall below what Medicare pays, physicians said.

"Unfortunately, I have to run a business,'' Haworth said Wednesday. "I can't afford a reduction like that, so I had to make a difficult decision and drop that insurance. I don't want to lose patients, but this kind of puts us in a bind.''

If Haworth's patients want to stay with her, they will either have to change insurance providers or pay more out of their own pockets for her services.

The 251,000 Nevadans insured by Anthem Blue Cross Blue Shield might face similar choices. The company, which is a subsidiary of WellPoint Inc., insures about 157,000 residents of Clark County.

David Meyer, a Haworth patient since 2001, said he won't be able to afford the higher out-of-pocket costs. He and his wife, Martha, will likely find another family physician.

"I'm not only giving up my family care doctor but my rheumatologist as well,'' said Meyer. "It doesn't feel good to walk into your doctor's office and read a sign that essentially says you can no longer be their patient. I like having someone who knows me.''

Another patient, Patricia Towne, said she's staying with Haworth.

"I'm not changing doctors -- no way,'' she said Wednesday as she signed in for an appointment.

But Towne said the changes are "aggravating and very upsetting." Towne said she talked to her employer, who called the company, and "they couldn't give her any answers."

"I learned because one of my friends told me,'' she said.

Anthem Blue Cross Blue Shield officials said they don't know how many of their 4,000 network providers will remain with them once the rate changes take effect.

Dr. William E. Bannen, regional vice president of health care management for Blue Cross, said Wednesday the company alerted about 2,000 providers of the changes by mail, but had not notified its members.

Bannen said providers were given 30 days to make a decision and another 90 days to cut ties with Blue Cross.

While it's not the largest health insurer in Nevada, Blue Cross has the state's largest provider network.

Bannen said he expects some doctors won't accept lower payments from the company.

"If we lose five or 10, it's not a huge deal,'' he said. "We have to be competitive. ... And in order for us to be competitive, we needed to revise our pricing structure with the other larger health care insurers. ...

"There is going to be a lot of pain in this process for our providers and for our individual members, but this is something we have to do to stay competitive.''

But Dr. Michael Colletti, a Las Vegas rheumatologist, and Haworth said they don't understand Blue Cross' explanation of the changes. Both physicians said other insurers are not announcing lower rates.

"I'm not having that problem with any others,'' said Colletti who stands to lose 10 to 15 percent of his patients over the rate change. "Any insurance company I'm going to be a part of should be matched or closely matched with Medicare reimbursements.''

Haworth said she doesn't accept patients whose insurance provider reimburses less than Medicare.

If this is a trend among health insurers, physicians aren't going to be able to survive, Colletti said.

As an example of how his reimbursement rates will be affected by Blue Cross' decision, Colletti said he is paid about $87 for a Medicare patient's office visit. For a Blue Cross patient's office visit, he will receive just $47 after the June 1 rate change.

For consultations, Colletti said, Medicare reimburses him about $218. Blue Cross is proposing $153.

Dr. Rudy Manthei, an ophthalmologist and chairman of Keeping our Doctors in Nevada, said he doesn't blame Blue Cross for trying to stay competitive. He said Blue Cross is one of the few insurance providers that has paid reasonable reimbursement rates.

The problem is with others, such as Sierra Health Services, which he said has leverage with physicians because of its size.

"Now, the other insurance companies are having a hard time with costs. In order to compete, they are dropping their rates down to Sierra's levels,'' Manthei said.

The concern now, Manthei said, is that the quality of care might go down because physicians will have to see more patients and do more procedures to offset the lower reimbursements. In the process, doctors will spend less time with their patients and think twice about purchasing newer technology, he said.

"This creates a vicious cycle, and physicians are in no position to work a deal. It is illegal for us to collectively bargain. It will take federal legislation to change that,'' said Manthei, who plans to no longer accept Blue Cross.

In the last four years, the federal government has reduced Medicare rates by about 18 percent, Manthei said. The problem for patients and doctors has been compounded by health insurance carriers dropping their rates to Medicare levels, he said.

Haworth said it was painful to have to put up signs telling patients she would no longer accept Blue Cross. But if she kept the insurance provider she would have to take on 40 to 50 more patients.

"I want to spend time with my patients,'' she said. "With family practices, we build relationships. I know that person. I know how their bodies work; and when you change a person's family physician, they have to start all over again building that trust and respect.''

Officials with the state's Department of Health Services and Insurance Division said Wednesday the agencies have no jurisdiction over health insurance contracts.

"They are proprietary,'' said Van Mouradian of Nevada's Division of Insurance.