Diabetes and high blood pressure require the careful oversight of a good family practice physician - one Claudine Gilbert might not be able to see any more.

Gilbert, a Medicare recipient, is a patient of Western Medical Associates, a large Casper primary care practice that announced Friday it will opt out of several forms of health insurance, including Medicare, because of their low reimbursement rates.

"It's going to hurt a lot of people," Gilbert said. "Who are we going to get to be our doctor that we could trust?"

Her husband, John, isn't on Medicare yet because he's only 64. Medicare is the federal government's health insurance program for those 65 and older.

Claudine Gilbert worries about what happens next year when he becomes eligible for Medicare. Her husband has leukemia.

She said she has never had a problem with Medicare and Western Medical before.

The Gilberts aren't the only people worried about what happens if Western Medical Associates stops accepting certain insurance.

Western Medical is the largest private family practice office in the state, with six physicians and two physician assistants.

In a press release dated Saturday, the chief executive officer of the practice said it will opt out of Medicare, Tricare for veterans and Blue Cross Blue Shield Sept. 1 and Medicaid Oct. 1 if negotiations for better reimbursement fail. (Blue Cross Blue Shield is the Star-Tribune's health insurance provider.)

This could affect between 10,000 and 15,000 Medicaid and Medicare patients in the office.

Western Medical CEO Richard Blauvelt and one of the physicians in the practice met with state officials Monday afternoon to discuss ways the practice can increase Medicaid reimbursement.

Dr. Brent Sherard, director of the Wyoming Department of Health, said the meeting "went well."

Medicaid, which is for low-income people, is funded by both state and federal governments, whereas Medicare is solely a federal program.

Sherard said the health department and others would prepare a response to the concerns raised by Western Medical.

"We want to ensure patients have access," Sherard said. "I am encouraged by the meeting."

The other health care plans haven't responded, Blauvelt said in the press release.

Lenora Forgey said she "hasn't a clue" where she will go for care if Western Medical stops seeing Medicare patients, noting the physician shortage in Casper. The woman, who is almost 70, has been a patient of one of the physicians for about 15 years.

"I've been upset and angry," Forgey said. "It's thrown me for a huge loop."

She's worried about her prescriptions that are all under the direction of her Western Medical doctor. She said she will probably end up going to the hospital for care.

"I guess it was a form of security to know I have a physician to take care of me if I need it," Forgey said.

Before Western Medical Associates, the Gilberts didn't have a primary care doctor, and John Gilbert ended up in the hospital.

In the press release, Blauvelt said another reason for dropping the insurance programs was to reduce the practice's three-month waiting list to see a physician. He said they are giving priority to patients with insurance that pays the physician fairly.

Claudine Gilbert said sometimes she can get in the office within the week she calls, depending on how serious her problem is. Other times she has to wait a month.

The wait doesn't matter, she said.

"At least we know when we get in, we get the care we need."

Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@trib.com.