ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Wednesday, October 30, 1996 TAG: 9610300032
SECTION: BUSINESS PAGE: B-6 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
Optimum Choice Inc. Advantage has notified nearly 6,000 elderly and disabled Virginians that their health insurance will be canceled Dec. 31. The company said it is withdrawing from most of its Virginia markets.
More than 100 Western Virginia residents were among those who bought the Medicare HMO, which had been marketed since June.
The insurance HMO eliminated the need for Medicare supplemental policies. It was especially attractive to disabled Medicare recipients younger than 65 because it included a drug card not available through other policies.
People who bought the insurance were expected to receive care from a particular network of doctors and one hospital system. In this area, it was affiliated with hospitals operated by Columbia/HCA Healthcare Corp.
Optimum Choice is a subsidiary of Mid Atlantic Medical Services Inc., which is based in Rockville, Md., and has an office in the Roanoke Valley. Its Advantage policy was the only Medicare health maintenance organization in the area.
The company will continue to sell the HMO insurance in the Arlington and Fairfax areas, a spokesman said. Its Optimum Choice plan sold to commercial groups is not affected by the decision to withdraw from other Virginia markets.
The Optimum Choice spokesman said the amount Medicare was willing to pay was too low for the HMO to be profitable except in larger metropolitan areas, where there generally is more competition among hospitals and doctors.
The company is pulling the Advantage program out of 59 cities and counties, including the Roanoke and New River valleys and Bedford.
Medicare's per-person rates differ from county to county, the MAMSI representative said.
Shannon Abell, assistant finance director at the Area Agency on Aging in Roanoke, said his office was busy Tuesday answering calls from Advantage policyholders asking how to get new coverage.
They will return to a regular Medicare coverage program, but, as the letter being sent from Optimum Choice Advantage points out, they can buy supplemental insurance to cover those services not paid by Medicare.
Such supplemental policies are what the Advantage customers canceled when they bought into the HMO. Abell said some who bought Advantage won't be able to return to their previous insurer at the same rate, although most probably can.
People 65 to 69 years old and insured by the American Association of Retired Persons or Trigon Blue Cross Blue Shield should not have problems getting their former coverage back, but others with pre-existing conditions might have to wait up to six months, Abell said.
Medicare recipients who need help finding supplemental policies can call the Area Agency on Aging Office at 345-0451. The number for Optimum Choice Advantage in the Roanoke Valley is 989-0721; the company's national 24-hour number is (800)280-6723.
LENGTH: Medium: 57 linesby CNB