In ths middle of a medical crisis hospital group kicking medicaid patients to the curb.

[Karl_K]

They just spend millions of dollars building a new building a lot of it using government grants and community money and now they are dumping thousands of low income patients.

Mercyhealth no longer accepting patients with IlliniCare, Meridian, Molina Medicaid

Mercyhealth says it will no longer accept patients with IlliniCare, Meridian, or Molina Medicaid after 90 days and Blue Cross Blue Shield Medicaid after six months.

www.wifr.com

They are the second large medical groups to do this in the last 8 months just in my area.
Get millions of dollars from the community and the government then dump patients.

OSF HealthCare will terminate contract for Meridian Medicaid, Medicare plans

PEORIA — OSF HealthCare patients using Meridian Medicaid and Medicare plans may have to find different providers. The health-care network announced

www.pjstar.com

 

[DAF]

As someone who works in healthcare and sees yearly decreases in reimbursement from insurance companies, I'd like to present a slightly different viewpoint. The hospital system is not dumping their patients, they're dumping the insurance companies. As most ambulatory Medicaid patients are in HMOs, the same rules apply for reimbursement: proper referral and authorization. Despite this, sometimes reimbursement is poor or the insurance companies refuse to pay, even if preauthorization was obtained. Even with all of your ducks in a row withclaim submission, they still sometimes refuse to pay, necessitating more manpower to fight the denial and get paid. Or, if something is not covered in full by the Medicaid HMO, the hospital cannot balance bill the Medicaid patient for the difference. The patients who use this hospital system for the most part are allowed to change their HMO whenever they want. It usually takes about 90 days for the changes to take effect. It is incumbent upon the patient to find out what insurance plans their physician and hospital system does accept and initiate that change. Ninety days and six months notice IS adequate time for patients to select a Medicaid HMO that the doctors and hospitals do participate in. Also to consider is that come contract negotiation, sometimes they can't come to an agreement on reimbursement rates and they just have to say bye-bye to the insurance company.

 

[Karl_K]

Its the same as dumping patients, as the patients are required to have a medicaid hmo to get medicaid coverage here.
The medical groups took millions of dollars from the community to build fancy buildings then kicked the most vulnerable patients to the curb.
The ones removed by mercy cover something over 90% of medicaid patients in this area.
Changing medicaid hmo's even if you can find one that your doctor will accept is not trivial to do right now.

 

[LightBright]

As someone who works in healthcare and sees yearly decreases in reimbursement from insurance companies, I'd like to present a slightly different viewpoint. The hospital system is not dumping their patients, they're dumping the insurance companies. As most ambulatory Medicaid patients are in HMOs, the same rules apply for reimbursement: proper referral and authorization. Despite this, sometimes reimbursement is poor or the insurance companies refuse to pay, even if preauthorization was obtained. Even with all of your ducks in a row withclaim submission, they still sometimes refuse to pay, necessitating more manpower to fight the denial and get paid. Or, if something is not covered in full by the Medicaid HMO, the hospital cannot balance bill the Medicaid patient for the difference. The patients who use this hospital system for the most part are allowed to change their HMO whenever they want. It usually takes about 90 days for the changes to take effect. It is incumbent upon the patient to find out what insurance plans their physician and hospital system does accept and initiate that change. Ninety days and six months notice IS adequate time for patients to select a Medicaid HMO that the doctors and hospitals do participate in. Also to consider is that come contract negotiation, sometimes they can't come to an agreement on reimbursement rates and they just have to say bye-bye to the insurance company.

It is absolute insanity to think that American citizens are to blame for their inability to get adequate healthcare when they are PAYING for healthcare insurance. What are they paying for? Does anyone sign up for medical insurance thinking that they will be kicked out of hospital systems? Your statement, though factual, and I appreciate it (it is interesting to me that caregivers know about all the money problems) hurts my heart. This is how the medical world thinks about us, that we are deserving of care based on our insurance and it’s our fault/we deserve it if we can’t get adequate care? It is devastating to know that there is a tiered system in medical care that is fully understood to be tiered by every member of the corporate medical industry. The patient should have known that they would not be able to use good hospitals when they signed up with an INSURANCE company. Hurts. My. Heart.

Well, come to think of it the medical staff were complicit in understanding that my father’s insurance company (Medicare) was costing them profits and they were very happy to kick my father out of his hospital bed and send him home. The hospital sent my convalescing father home in a van at 10pm at night. After a hip replacement, subsequent line infection, and heart problems, his insurance company refused to pay for any more care. It was completely shocking.

Compare this with my own experience when I had platinum medical care from my husband’s insurer and each medical facility I visited was competing for my care! Like, phone calls, emails, gift baskets, hours of time with physicians trying to recruit me, all of it fading when they had me signed up. Once you have the platinum patients secured you can treat them like every other patient.

Our American healthcare system chills me to my very soul. That there is a dollar sign on every patient, and acquiescence to stone cold capitalism within medical care is shocking to me.

 

[chrono]

Our American healthcare system chills me to my very soul.

The US Healthcare and insurance system is broken. The ongoing problem is that there's still no solution to it. I don't claim to know any solution but I grew up where there's no such thing as health insurance. Everyone pays the doctors and hospitals out of pocket with cash and there's pretty much a standard rate for all procedures, unless you visit private hospitals and clinics.

 

[Matata]

It is absolute insanity to think that American citizens are to blame for their inability to get adequate healthcare when they are PAYING for healthcare insurance. What are they paying for?

Your entire first paragraph lists the reasons I don't understand why so many people got upset when ACA was being launched and they thought they would have to give up their insurance. Same thing happened with Sanders' medicare for all. A lot of Americans vowed that no one could take away their god-given right to choose their health insurance. So they'd rather have inadequate insurance at the hands of crooks than take a chance on decent health care?

Four years ago on a trip to Scotland I urgently needed the services of a chiropractor. Found one open on a Saturday and even though he was booked up he said he'd stay open longer to see me. He spent 1.5 hrs with me, taking my medical history and putting me through various stretches and adjustments. He charged me less than $50 Euro. I spend more than 3x that for 12 minutes with my chiro here. His thoroughness was extraordinary to me compared to what I've seen here. When I told him what my chiro charged, he was flabbergasted. He did say he wished he had more options to earn more money but seemed appalled at what doctors earned in the US compared to Scotland.

There is no easy way to reform health care and insurance in the US but that is not a reason for us to continually fight against every new govt sponsored idea. There is a middle ground to take and baby steps to make that I believe would lead to better systems overall but we seem loathe to change and would rather complain.