It's debatable if the fiduciary standard is 'higher' than suitability. But the better question might be, who's holding the bar?
Dec. 02--Carlisle Regional Medical Center will no longer accept Medicaid members of Gateway Health Plan as of Jan. 1, 2013.
"Gateway has been in contract negotiations with the company that manages Carlisle Regional Medical Center for over a year," said Margaret Worek, vice president of operations for Gateway. "And we did reach an impasse in negotiations and a termination at the end of September."
Worek did not divulge specific information pertaining to the breakdown of negotiations but said Gateway mailed letters to its members mid-November about the contract termination. In the letter, members were advised to switch providers or Medicaid plans to avoid a lapse in coverage.
Tara Mead, director of marketing at CRMC, explained a little about why contract negotiations failed.
"Gateway has demanded that our hospital accept a contract renewal that decreased the rates to be paid to the hospitals substantially while hospital costs have continued to increase," Mead said. "While our hospital-affiliated physician groups are not part of this negotiation, Gateway requires physicians to admit to an 'in-network' facility. For this reason, Gateway may not allow these physician groups to continue to see patients who are members of their health plan."
"We all play an important role in improving quality and efficiency, and insurance companies must do their part too, and that includes fair payments," CRMC CEO John Kristel said.
Holy Spirit Hospital and PinnacleHealth both accept Gateway Health Plan and will continue to do so in 2013, but for Medicaid members in western Cumberland County, the failure in negotiations means trekking more than 20 miles to the nearest treatment center.
"Pennsylvania members with Gateway Medicaid insurance have the right to change their managed-care health plan at any time to ensure their provider of choice is 'in-network' by contacting PA Enrollment Services," Mead said in a statement Thursday.
Mead said Carlisle Regional Medical Center still accepts Medicaid plans through AmeriHealth Mercy and United Healthcare. It also will continue to accept Gateway Medicare plans.
The Gateway Medicaid Health Plan provides medical assistance to 255,000 low-income families as a subcontractor for the Pennsylvania Department of Welfare'sMedicaid/Medicare programs.
"Medicaid (and Medicare) are a vital lifeline for Pennsylvania families, seniors, children and people with disabilities," said Antoinette Kraus, director of the Pennsylvania Health Access Network. "These programs allow low-income individuals to access preventative care, follow-up visits after serious illness, prescription drugs and regular checkups. Individuals with health insurance visit emergency rooms less and are more likely to report being in good health than those without health insurance."
(c)2012 The Sentinel (Carlisle, Pa.)
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