For Allen, who is also an oncology certified nurse, this has been one of the biggest issues they have struggled with at the center.
“One of the big things with a medical practice, all physicians can say is that they’ll treat a patient regardless of their insurance. We look at any patient blindly,” he said. “For a practice that treats every patient the same, to be told to treat a patient differently by a carrier is a huge problem. In fact, I think it’s borderline unethical.”
Some patients have been forced to cover the costs of their own medications, or find an alternative in the middle of their chemotherapy and recovery processes, Allen and Wilcher said.
In October, Kentucky Spirit announced plans to terminate its Medicaid managed care contract with Kentucky, which will become effective by July 5, 2013. In a press release, the company stated that there have been concerns since the beginning regarding “sustainability of the Commonwealth’s Medicaid managed care program.”
Companies have alleged they were misinformed by the Commonwealth when they began bidding to be an MCO in the state. In a lawsuit filed by Kentucky Spirit in October, the company stated Gov. Steve Beshear rushed the privatization option in early 2011, causing the data to be incorrect and their cost estimates to be incorrect.
This may have been a problem, not only for the companies, but for the patients as well.
Wilcher explained that there is a great deal of confusion for patients during the transition to MCOs simply because the information regarding the individual MCOs wasn’t readily available. There even seemed to be confusion among the MCOs about what was to be offered, she said.
“One big barrier we had was obtaining the information about what was covered and what was not covered. Unfortunately, the MCOs themselves were not clear on the information,” Wilcher said, adding that some patients blindly chose their MCO simply so they would be covered.
Wilcher said that the privatization of Medicaid is good in theory, the flawed system developed in Kentucky has added to an already enormous strain. She said it’s best described as a “work-in-progress.”
“Their ultimate goal to save the state money was great, to institute new guidelines so that there is a better coordination of care for the patient,” she said. “The problem is they did not have that internal coordination to make that greater goal work.”