White County medical community speaks out on TennCare controversy

Posted By | June 13, 2002 12:00 am

Universal-TennCare debate continues
Rima Austin
As debates over the Universal-TennCare crisis continue at the Capitol, local physicians are determined to stick it out and stay true to their patients. Universal Care of TN, Inc., an MCO for TennCare, issued a statement on May 9th saying they have put several million dollars in an escrow account, which will be added to by Health Care Financing Administration (HCFA) and TennCare.
This money will be used to reimburse providers for unpaid claims prior to April 12th. They promised to pay 70 percent of any money owed to providers from April 13th to the present. If this agreement is not accepted, then Universal will be forced to go into receivership. If this happens, it will be a question as to whether or not the money gets paid at all.
TennCare was established in 1993, replacing the outdated Medicaid system. It took on the state’s 700,000 citizens already enrolled in the Medicaid program on January 1st, 1994, along with an additional 400,000 uninsured people. Currently, it registers over 1.1 million people.
The alleged breakdown of TennCare was due to the withdrawal of the Managed Care Organization, Blue Cross, who, before June 30, 2000, represented at least 40 percent of all recipients of TennCare. This forced the state to take on several smaller MCO’s, with one of them being Universal. The others were Better Health Plans, Inc., HealthCare Solutions of Tennessee, Inc., Tennessee Health Partnership, Access Med Plus and Xantus.
After Universal signed on, it also began to spiral out of control. Once again, physicians were not being paid for services rendered. “In terms of getting services that are needed to the patients, the whole system is top-heavy in bureaucracy and paper work, that it becomes exceptionally difficult to care for patients,” said Dr. Ty Webb, a White County family practitioner. “From a business standpoint, TennCare is a losing proposition.”
Webb went on to say the insurance industry runs medicine now and they decide what they want to pay. When asked how he felt about the 70 percent Universal is offering, he stated, “I find it offensive.”
Universal owes Webb’s office approximately $70,000. “From a physician’s standpoint,” said Webb, “the reason we’re in medicine is to provide care for people, and in this area, physicians have done that very thing.”
Ron Dyer, MBA and Chief Financial Officer for White County Community Hospital affirmed Webb’s comments. “The problem is, I think, people like HCA and some other large hospitals, or hospital chains, are refusing to accept the offer,” he said. “If they refuse, I just don’t know what it is going to do to our ability to negotiate with Universal.”
Universal owes White County Hospital a gross amount of approximately $1.8 million dollars. However, according to statements issued by Universal, they too, will see only the money owed to them since April 12.
Another provider having trouble with Universal is the office of Dr. Don Pate, who is already owed approximately $7,000. As far as getting the money owed to them, Helen Pate, office manager, said, “We would love to see that happen.”
Helen stated Dr. Pate’s office has no plans to turn down any patients because their insurance companies cannot pay. “Patients can”t help the plans they have,” she said. “The problem lies within the system.”
Even with bad feelings against the TennCare system, White County’s medical community, as well as residents, have been sitting on edge, waiting and hoping the TennCare roller coaster ride will soon be over. Helen summed up the situation in one sentence, “The problem has gone on for so long, that we are almost out of emotion.”

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