Most of us say "thanks" without thinking.
July 31--Some area independent health care providers, such as nurses and home health aides, are putting up their hands and leaving their long-term professions after going months without a paycheck.
The local workers -- part of a pool of 29,000 providers in the state -- are facing delays in having claims processed by the insurance companies Molina and Aetna, now under contract with the state of Ohio as two of five plans in MyCare Ohio, a three-year demonstration to coordinate benefits for those getting both Medicaid and Medicare.
The new program launched May 1, and now covers 106,000 Ohioans in 29 counties.
Since the launch, MyCare Ohio plans have paid $73 million for about 150,000 provider claims, according to the Ohio Department of Medicaid. But there remains delays in payments for independent providers.
Jenny Streibick, of Middletown, said she's been an independent provider through the Ohio Department of Job and Family Services for over 15 years, and is now having to leave several clients due to going unpaid since May 31.
"May 31 came and it was like we were orphaned; we were given next to no information," Streibick said.
Streibick said Aetna owes her over $5,000 in claims since June. She knows another independent provider whose car was repossessed because she couldn't make payments.
"We are sorry that this situation has caused delayed payments to some health care workers," said Rohan Hutchings, spokesman for Aetna. "We have been working with health care agencies and individual providers to get payments out as quickly as possible. Our teams are working extremely hard and late into the night to get this situation resolved, and we have sped up the processing of payments to twice a week."
Hutchings said it's been due to "technical reasons" that the providers haven't gotten their claims fulfilled. He said providers who've been identified as not getting paid have been placed on a "priority list."
"We're working to get cash into people's hands," Hutchings said.
Streibick said for the first time in over a decade she had to file a paper claim to Aetna.
"Talk about going backwards," Streibick said. "We should charge interest on the money they owe us."
Streibick said for one client in Middletown, she's been trying since June 1 to reach the woman's new case manager through Aetna but hasn't had any luck. Streibick said the inability to reach her client's case manager has caused the woman's physical therapy to stall because it has to be pre-approved every few weeks.
"I worry about her from a nursing standpoint," Streibick said."No one's following through. I've been on the phone every day. What kind of accident are they waiting for?"
Streibick said after two months of non-payment, she's now leaving being an independent provider to work for a larger agency that can get claims processed more timely.
Other independent providers on that same woman's case in Middletown -- Connie Lambert, of Preble County; Jodi Million, of Middletown; and Julie Bowman, of Middletown -- also told this newspaper they have to leave the client because they can't afford not getting reimbursed.
Streibick said for her clients on the Molina plan, she's able to enter claims online but has still only received one check from Molina since June.
Laurie Petrie, spokeswoman for Council on Aging of Southwestern Ohio, said the non-profit agency is a provider of case managers for Aetna and Molina in MyCare Ohio.
"There's nothing we can do to get these providers paid," Petrie said.
Petrie said the providers most affected by non-payments in MyCare Ohio have been independent ones, such as a home health care aide working for herself.
"Working for themselves, they can't go without income for a month," Petrie said. "They're trying to absorb the loss until it gets straightened out. The payment system is more complicated than before."
Petrie said MyCare Ohio has been a "mass endeavor" with 19,000 people enrolled alone in this region. She said it can be a "tremendous personal loss" for an individual to lose their long-term home care provider.
"For a lot of people, this is someone that gives them baths and is deeply involved in their personal life," Petrie said. "They come to depend on them and to see them leave ... it's very hard on patient and provider."
Tim Hymer, of Liberty Twp., said he's been receiving Medicaid and Medicare benefits since a diving accident 20 years ago. He said Jenny Streibick has been his nurse for 15 years, and she broke the news Wednesday that she has to move to an agency.
"She's more or less a family member now," Hymer said. "My dream would be Aetna and Molina get it fixed quick."
Hymer said his mother and brother are also independent providers that help to care for him. They also haven't gotten paid for seven weeks, and his brother is getting hit with overdraft and late fees.
"It's amazing how deep this goes and everything is really slow getting fixed," Hymer said.
Amy Clubbs, president of Molina Healthcare Ohio, said the launch of MyCare Ohio has "gone really well" for Molina consumers. She said care managers are currently setting up in-person health-risk assessments to gauge the consumers' health needs and ensure services and supports are in place.
"We have heard from a lot of the independent providers, with MyCare being a new program, issues getting billings incorrect," Clubbs said.
Clubbs said since May the insurance company has hosted over 50 online and in-person training sessions that over 800 providers have attended to learn the process for submitting claims through a secure online portal.
"There's a lack of understanding on how to process claims in our system," Clubbs said.
The contract for being a MyCare Ohio plan stipulates the insurance companies pay 90 percent of claims within 30 days and 99 percent of claims within 90 days. She said the company is sitting at about 95 percent of MyCare Ohio claims being processed within 30 days.
"(The providers) are used to getting paid faster and that could be causing the angst," Clubbs said.
Patti Carter, of Fairfield, co-owner of Amenity Home Health Care that services Butler, Hamilton and Clermont counties, said her business hasn't received payments since May 31 for its 132 clients enrolled in MyCare Ohio.
She said non-payments in MyCare Ohio are affecting not just nursing homes, but skilled and unskilled agencies, medical suppliers, home health care agencies and mental health agencies.
Carter said some of her medical suppliers are no longer delivering needed supplies, such as diabetes medications and colostomy bags, due to not getting payments from Medicaid.
"An insurance company should have never had their hands in this," Carter said. "It's more hands in the pot, and it's not reducing paperwork."
The need for a coordinated system like MyCare Ohio was introduced in 2011 by Gov. John Kasich.
The five established goals for the three-year demonstration of MyCare Ohio are: improve health outcomes; identify ways to reduce overall costs between the systems; provide a single point of contact for consumers; establish a delivery system that's easy to navigate for the individual and provider; and create a seamless transition between care settings and programs as the consumer's needs change.
Of the 2.6 million Ohioans on Medicaid, about 182,000 of those are also eligible for Medicare. That dual-eligible population accounts for 14 percent of the Medicaid population but 34 percent of the costs.
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