Keystone Mercy subscribers get erroneous letter saying Temple was out of the plan

Letters were sent in error Monday to more than 27,000 Keystone Mercy Health Plan subscribers saying that the Temple University Health System was no longer part of the plan and that they would have to find new doctors.

They were followed Wednesday by 27,000 mea culpas.

It was "a very regretful mistake," said Donna Burtanger, a spokeswoman for Keystone. She said she first learned of the accidental mailing on Tuesday, when subscribers began calling the health plan.

Keystone and Temple were in negotiations for a new contract that would begin March 1 when a letter to subscribers was prepared in case no settlement was reached, Burtanger said. The letter was sent to a vendor that handles mail. The state requires that subscribers receive 30 days' notice of termination.

A new contract was successfully completed within the last couple of weeks, Burtanger said. She could not provide the date or details.

But on Monday, she said, "our vendor inadvertently mailed the letters."

Exactly how that happened has not yet been determined, said Burtanger. She would not name the vendor, saying only that Keystone has had a long-standing relationship with the company.

The vendor sent the second set of letters free, she said. The health plan also put a notice on its website, set up call lines for questions, and is preparing posters for Temple medical offices in consultation with the state Department of Public Welfare.

The Temple health system includes Temple University and Jeanes Hospitals and the Episcopal Campus, which provides psychiatric services. It is heavily dependent on Medicaid, which made up 44 percent of its payments last year.

Keystone Mercy is the largest Medicaid managed-care provider in Southeastern Pennsylvania, with about 300,000 subscribers. The letters this week were sent to 27,000 of them who were in treatment with a Temple provider or had seen one in the last year, Burtanger said.

She said that fewer than 100 people called the insurer about the termination notice Tuesday and Wednesday.

"It was a mistake. You could say, no harm no foul," said Richard Weishaupt, senior attorney at Community Legal Services of Philadelphia.

"What would be a big deal would be if it were true," he said. In a managed-care plan such as Keystone Mercy, Weishaupt said, a patient's primary physician acts as a gatekeeper for almost all services. Losing coverage for the physician would mean a patient would have difficulty seeing specialists or receiving hospital services.

Although this case was an error, plenty of patients on other health plans have had to change doctors or experienced the anxiety-inducing 30-day notice as negotiations between hospitals and insurers have become difficult.

Indeed, Mercy Keystone subscribers whose doctors are part of the unrelated Crozer-Keystone Health System received just such a letter a year ago. The contract was settled, but not before thousands of patients were assigned new doctors.

The region "has a highly concentrated commercial insurance market," Kenneth J. Braithwaite, executive director of the Delaware Valley Healthcare Council, said in an e-mail. "With these market dynamics, hospital/insurer negotiations have become more contentious in recent years," often alarming patients and their health-care providers.