Nola Sizemore

Staff Writer

Mark Bell complimented the chamber on their efforts to organize a recent rally regarding a dispute between ARH Health Care and Coventry Cares Health Insurance. He said the rally was cancelled, but could be re-organized if an agreement is not reached by June 30.

“Coventry has sent a letter to Baptist Hospital saying they will not renew their contract that is up in November,” said Bell. “Kings Daughter Medical Center, in Ashland, also received a letter three weeks ago from Coventry.”

Harlan ARH Hospital Revenue Cycle Manager Anne Hensley said Coventry began sending letters last week to individual physicians in our service area cancelling their contracts.

“The state has committed to opening the enrollment back up, but they would have to put them all, at this point if nothing changed with Kentucky Spirit and Coventry, with Well Care,” said Hensley. “Well Care is $400 a month per person. I think Coventry was $436 per month and Kentucky Spirit was $330 per month.”

Hensley went on to say she was informed that Coventry is threatening to drop 10 more hospitals. She said in other states hospitals had 18 months to implement changes, but Kentucky was only given almost 3 months.

“Coventry has about 143,000 people covered in Kentucky,” said Hensley. “To try to switch that many people over….We still have physicians that Well Care has been unable to get into their system today and that’s since Nov. 1. There’s nothing we can do to help with that conversion if they actually do the conversion. It was explained to me that Well Care is having trouble with their software and Well Care says ‘we’re working on it.”

Bell said at this point, in this community, we’re in better shape than we were. He said it’s” not a done deal.”

“It’s an ongoing situation and we’re just going to have to stay on top of this and do what we can,” said Bell. “It’s still an issue out there that people in eastern Kentucky will have to deal with. Legislators, at this point it looks like, are going to demand to be a part of this as it moves forward. We’re just going to have to wait and see how this plays out. The next step is that this has to become a part of the politic discussion, and up to this point it hasn’t been. It’s been the governor’s office who have decided how things are going to go.”

Chamber member Cathryn Forester said if Coventry’s issue is that their costs are disproportionate for this area compared to the other areas, won’t Well Care be in the same position if they take Coventry’s coverage over. She said she wasn’t sure how much of this dispute is the insurance company and how much is the set up from the state.

“The state is looking to save $340 million over three years by using this model, ” said Bell.

“With managed care they should have managers that are actually on site,” said Hensley. “The problem is they have put no case managers in this area so when you call for authorization, they refuse them. So, you’ve got the patient not being provided care even though they may be having an acute episode. There’s nothing wrong with a managed plan if they are administered correctly. It’s a good type of program, but the problem is they came in here and they didn’t have resources in place to implement a managed care plan.”

Bell said their only option was “to manage the money and ration care, and they rationed care by saying we’re not going to pay you.”

“If you’re not going to manage the patient, then you’re going to manage the money,” said Hensley. “These are for-profit companies and, personally, I don’t know what they were thinking when they signed these contracts. They have had a contract in West Virginia for the past four years and we’re no more high risk than West Virginia.”

Chamber member Roger Fannin said for a company as experienced as Coventry, that has been in Appalachia for the past four years, he just wasn’t “buying this.”

“This seems like a power grab — a money grab,” said Fannin. “I don’t know — this just doesn’t smell right.”

Chamber member Dan Mosley said the governor has not come forth and said anything about this dispute at this point. He said maybe this was a “rush up job during the governor’s re-election campaign.” He said Sen. Brandon Smith has indicated to him he has not received a full copy of the contracts to date.

“Isn’t this just a symptom of the federal government assigning the state to manage the Medicare money that the federal government collects from all of us,” said chamber member Pete Poynter. “They don’t have enough money to manage it themselves so they’re going to give it to the state. The state doesn’t have enough money to manage it so they pawn it off to another company to manage it for them on a fixed budget. What you’re going to see from this point forward is some kind of rationing health care and managed money. They had no intention of managing the patient.”

Hensley said one of the things she has read in the Obama Care Plan is that if you are 75 years old and you develop cancer, Medicare will pay for no treatment. She said in the plan, every five years after you turn 75, You will be mandated to attend a life-ending counseling session. She said these counseling sessions are to prepare you to die without health care.

“Another thing under the Obama Care Plan, the federal government will have access to your bank account and they will be able to deduct money from your account directly without your authorization or without you knowing about it until you receive your bank statement and see checks start bouncing,” said Poynter.

In other chamber action Bell noted a $78 million road plan was passed for Harlan County. He said the majority of that money is federal money designated for U.S. 119. He said other state projects will also be included in this plan.

Reach Nola Sizemore at 606-573-4510 or at nsizemore@heartlandpublications.com