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    Tuesday, October 12, 2004

    Kerry Plan in Action: John Kerry's plan to expand Medicaid to include the uninsured is already being done in Tennessee, as Doctor Mental has noted before. It isn't going well:

    In January 1994 - on McWherter's watch - TennCare replaced Medicaid as the state's health insurance program for poor and uninsured Tennesseans. It operates through a system of managed care organizations.

    Doctors and hospitals have complained ever since that the now $5.1 billion program has been underfunded by the state and federal governments, forcing them to carry too much of the cost. Citing inadequate compensation and paperwork hassles, many doctors and hospitals have dropped out of certain managed care organizations, and some have dropped TennCare altogether.

    Tennessee is trying to make things better by increasing funding to the managed care companies handling the Medicaid business, but doctors aren't optimistic it will make much of a difference on their side:

    ...But Dr. Charles White of Lexington isn't as hopeful. His office has accepted TennCare through four MCOs. He's dropped two MCOs - including TLC - and is considering dropping a third, Access Med Plus.

    "Just the fact of the state pumping more money into the program really doesn't mean anything that I can see because so far the managed care organizations have not improved their reimbursements to us," White said. "And again, reimbursement is secondary to these office hassles that we have to go through."

    White's office has had problems with MCOs contesting "clean" claim forms and not paying in a timely fashion, he said. Sometimes, a worker in his office is "on the phone for hours trying to get a referral or prior approval."

    "They just put you on hold and let you sit there - forever," White added.

    ...He also said some MCOs have a poor network of specialists. When they need to refer patients, it's difficult for doctors to find a specialist who will take TennCare.

    The problem of access isn't limited to specialists:

    ...The MCO-provider problems affect recipients like Ross. Reggie Henderson, who works out of White's office, had been Ross's doctor for eight years. But when the office stopped accepting TLC, Ross had to find another physician who would. TennCare recipients are required to have a single doctor or primary care provider. That provider does any necessary referrals.

    Ross now drives about 40 minutes from his home in Lexington to Decaturville to see a doctor.

    ...While Ross and Hatchett love TennCare, there have been cases of patients getting services they don't need, and cases of employers and insurance companies dumping patients into the TennCare program.

    Since Tennessee's program is basically the same program that Kerry wants to make national, it really should be getting more attention. It sounds good on paper, but in practice it's a nightmare.


    posted by Sydney on 10/12/2004 07:41:00 AM 0 comments


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