By Dave Ranney
KHI News Service
TOPEKA, March 8
UniCare Health Plan of Kansas is behind in its payments to hospitals treating children and pregnant women enrolled in HealthWave, the state”s health insurance program for low-income families.
“Our members have received a small fraction of what they”ve billed since Jan. 1,” said Tom Bell, president of the Kansas Hospital Association.
Lawrence Memorial Hospital, for example, hasn”t been paid a dime.
“They owe us $400,000, they haven”t paid any claims since the first of the year,” said Gene Meyer, the Lawrence hospital”s president and CEO.
Meyer met with several legislators Thursday. “This is a huge deal for us,” he said.
UniCare was awarded one of the state”s two managed care contracts in August 2006.
Bell said his office has not heard as many complaints about UniCare”s competitor, Children”s Mercy Family Health Partners. The companies” contracts took effect Jan. 1.
“We expected some delays and we knew that some payments might not be made right away
that happens,” Bell said. “But let”s just say, we thought those payments would have been made by now.”
Some
but not all
physicians have not been paid by UniCare.
“What”s happening is that a lot of docs who are seeing UniCare patients don”t have UniCare contracts,” said Jerry Slaughter, executive director at the Kansas Medical Society. “They haven”t been paid, but everybody else has been paid.”
Slaughter said he did not know how many
or what percentage of
physicians haven”t been paid.
“We”re just hoping this gets worked out,” he said.
Since last fall, the Kansas Health Policy Authority has consistently praised UniCare for its work in ensuring a smooth transition between contractors.
“The transition was seamless in terms of making sure tens of thousands of beneficiaries got all the services they needed,” said Marcia Nielsen, executive director at the health policy authority.
Nielsen said she”s troubled by the hospitals” complaints.
“We are in conversation with them about the significance of this problem and they recognize that if there”s not a quick resolution, the state will consider all other options,” she said.
Nielsen said she would not be hesitant to order UniCare to pay the hospitals in advance of the billing glitches being worked out.
Tish Hollingsworth, director of reimbursement at the hospital association, said UniCare officials have shared that they”ve not been able to load the state”s Medicaid fee schedule onto the company”s computer system.
“It is a complicated system,” Hollingsworth said.
Leslie Porras, a public relations director at UniCare”s parent company, WellPoint, said the company was aware of the difficulties.
“We have been working to expedite the process and load the state”s Medicaid fee schedule,” Porras wrote in an e-mail to KHI News Service. “We take this process very seriously and want to ensure our systems are effectively in order. We have been meeting with each of the hospitals to keep them informed of our progress.”
The missed payments have slowed cash-flow at several hospitals, especially those seeing high numbers of Medicaid patients.
“This is more than an inconvenience,” Bell said. “Hospitals are being put in a position of having to pull money out from other parts of their budgets or making decisions they”d rather not make.”
Bell said UniCare officials have been cooperative and communicative. Still, he said, hospital administrators are miffed that their staffs are having to spend time tracking down what turn out to be problems in UniCare”s computer system.
“In the bigger picture, it”s things like this that tend to be disincentives when it comes to getting providers to see Medicaid patients,” Bell said.
UniCare is owned by WellPoint, a for-profit corporation based in Thousand Oaks, Calif.
Prior to Jan. 1, FirstGuard Health Plan ran the state”s HealthWave program. The company was underbid by UniCare and Family Health Partners.
UniCare and Children”s Mercy now compete for roughly 145,000 HealthWave patients in the eastern two-thirds of the state.
UniCare is the sole managed-care contractor for 15,000 patients in 31 counties in western Kansas.
Children”s Mercy Family Health Partners is a nonprofit subsidiary of Children”s Mercy Hospitals and Clinics in Kansas City, Mo.
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
dranney@khi.org
or at 785-233-5443, ext. 128.