What can happen if Blues compete

Aetna had been an important insurer in the Lehigh Valley. But from 2002 until 2007, the network would not accept Aetna. "It took a little chutzpah to do it," Sussman said. "We were able to do that because of competition in the marketplace."

There are other advantages, Sussman said. When the network decided to expand the outreach of a dental clinic at its hospital in Allentown, Sussman went to the insurers, hat in hand, to fund a $900,000 mobile clinic. Capital ponied up $250,000, celebrating the occasion at a news conference attended by children at a local elementary school.

Highmark also has contributed, donating $100,000 in 2004 for a hospital-run osteoporosis prevention and education program.

Kitty Gallagher had hoped that competition would help her shake loose some key bargaining information.

As president of the Lehigh Valley Business Coalition on Healthcare, she negotiates health insurance for the 32,000 employees and family members of the Lehigh Valley's major employers, including Mack Truck Inc. and PP&L Corp.

"When the divorce first happened, I thought it was very positive," Gallagher said.

Most of her companies self-insure, meaning they pay claims directly. To service them, the insurers negotiate fee schedules with the hospitals and doctors, handle the claims and provide other services, such as disease-management programs.

Gallagher wanted to know what the insurers paid the doctors and hospitals. "We tried to play them all off against each other. I can't tell you how hard we fought toe-to-toe on it," she said. "They held us off."

Without that information, she still negotiates, but she would like to see more transparency.

Family practitioner Samuel Bub, of Emmaus, said competition was good in theory.

"But for the average physician in a small practice, we need to be part of both plans to capture the patients," he said. "A small group is in no position to bargain with either one of them.

"On a day-to-day basis, my focus is to see the patients."