Beneficiaries urged to check plan assignments

The state's reinvention of Medicaid, the federal and state program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities, has been approved and will roll out Jan. 1. Current beneficiaries received information packets in the fall, and were assigned to one of three managed health care plans with which the state is contracting.

Local providers are encouraging people to take a look at the plan to which they have been assigned.

Pratt Regional Medical Center, Pratt Internal Medicine Group and Pratt Family Practice have signed agreements with two of the three providers: Amerigroup Kansas, Inc., and Sunflower State Health Plan.

Currently, those providers are not signed up with United Healthcare of the Midwest.

"We were unsuccessful in trying to negotiate a contract," explained Susan Page, president and CEO of PRMC.

Some Pratt County beneficiaries, however, have been assigned to United Healthcare, and that concerns providers' business offices.

They will have until April 4 to switch to a different plan; after that they're locked in for a year.

"Don't wait, get it switched now," urged Pam Hostetler, office manager at Pratt Family Practice.

A patient who stays with United Healthcare, with which the office is not contracting, will be asked to pay for services up front, she said.

Jo Ruth, in the patient financial services department at Pratt Internal Medicine Group, said they took a proactive approach, contacting Medicaid beneficiaries several weeks ago, to let them know what companies they were working with, and including those logos, for easy recognition. She said the paperwork she has seen is fairly straightforward, with a telephone number to call to make a change.

A patient enrolled in United Healthcare will be seen in the emergency room at PRMC, and the hospital will bill the plan, and receive a reduced payment, said Rick Reber, director of patient and financial services. After that, the patient will receive a letter from the plan administrator, telling them to use a covered facility in the future.

If patients covered under Amerigroup or Sunflower plans use the emergency room for non-emergent care, they will be directed to a primary care physician within the plan.

"The primary care physician is the gatekeeper for the whole process," Reber said.

Managed care places more emphasis on keeping people well, by providing incentives for staying well and coverage for preventive screenings.

"It used to be that no insurance company, including Medicare, would pay for screenings, like mammography, and they would end up paying for breast cancer," Page said, explaining the cost-effectiveness of the managed care concept.

Current Medicaid beneficiaries who have not received a new KanCare card by Jan. 4 should contact the managed care organization (MCO) on the number provided in a packet mailed earlier.

KanCare will cover all services previously provided by Medicaid, as well as some "value-added" services that could be different with each plan. Patients can chose their own doctor, as long as the doctor is on the health plan's provider list. Coverage for children will be provided under KanCare; the HealthWave name goes away. Unicare and Coventry will no longer manage any Kansas Medicaid services, and the HealthConnect program ends Dec. 31.

Services provided through the Home and Community Based Services waiver for consumers with intellectual or developmental disabilities (I/DD) will be delayed for one year and will become part of KanCare in 2014.

Get help

• Call the business office of your provider

• PRMC patient and financial services: 450-1148

• Call the number listed on the plan information received.

• KanCare Consumer Assistance Line: 1-866-305-5147

• James Bart, KanCare Ombudsman: 1-855-643-8180 for help with unresolved access, service and benefit problems, especially for beneficiaries in the Home and Community Based Services (HCBS) Waiverprogram and others receiving long-term care services.