Health Providers Leaving Profession Over Payment Frustrations
|By Hannah Poturalski, Journal-News, Hamilton, Ohio|
|McClatchy-Tribune Information Services|
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
The new program launched
Since the launch, MyCare Ohio plans have paid
Streibick said Aetna owes her over
"We are sorry that this situation has caused delayed payments to some health care workers," said
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
"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
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.
"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."
"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.
"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.
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
"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.
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
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