I am the managing doctor for Kentuckiana Oral and Maxillofacial Surgery, a five-physician practice based in Jefferson and Bullitt Counties. I read with great interest the editorial about Passport that appeared in the June 5 edition of The Courier-Journal.
Our practice has been in network with Kentucky Medicaid since July 1, 2004, when we first opened our doors. Due to our specialty, we perform both medical and dental procedures, so we file to both medical and dental plans. Because we are located in Region 3, we fall under the Passport umbrella. Passport is the Kentucky HMO plan that covers 16 counties. But because we are referred patients from all over Kentucky, we see patients who are covered by the new Medicaid plans as well, so we also contracted with each new medical plan and each new dental plan. That puts us in a fairly unique position to have first-hand knowledge of how each plan works.
Passport puts the patients first. There’s no doubt in my mind about that. Their requirements for a patient’s care are well-outlined. They make it very clear to the medical and dental providers just what they will and won’t cover. Passport has streamlined the authorization process for large procedures, and they have eliminated authorization requirements for procedures that are performed on a daily basis or emergent in nature. Passport lets us spend our time doing what we do best — performing necessary medical and dental services. The medical staff and the business staff in our offices don’t waste time arguing with Passport trying to get permission to do necessary work or trying to get paid for the work that has already been done.
This cannot be said for the new plans. We have trouble getting even the most routine procedures authorized. Needed treatment is often denied or delayed. And I’m not talking about a delay of a few days — or a delay of a few weeks; I’m talking about a delay of a few months or more. And once the work is performed, the doctors cannot be sure if/when/how they’ll be paid.
Surely this is not what our governor and Medicaid commissioner had in mind when they contracted with these new plans. And, as medical and dental providers are opting out of working with these new plans, the number of our patients who are covered by these new plans is increasing. It is no longer unusual to have a patient drive from Pikeville or Bowling Green because they can no longer find an oral surgeon near their home.
So I have a few questions for those in Frankfort who are making these decisions:
• Why would you allow the new plans into Region 3 when you’ve seen the chaos they have created elsewhere in the state?
• Don’t you think it’s time to review the manner in which the new plans are paid? It is my understanding that they receive a certain amount of money at the beginning of each month. After they pay out a certain amount, the rest is theirs to keep. So when these new plans deny and delay care, they make more money. That has to be a conflict of interest. Perhaps we need more non-profit organizations like Passport handling these claims for service.
• Aren’t there companies in Kentucky who could handle the Medicaid claims? Wouldn’t it make sense to keep taxpayer money in Kentucky? Wouldn’t it make sense to work with companies that are based right here so oversight is easier?
My partners and I want to continue providing care to the Medicaid population, but if Gov. Steve Beshear and Acting Commissioner Wise choose to “open the floodgates” in Region 3, we may not be able to do so.
Let’s see if our government officials can’t figure out a way to bring the other 104 counties in Kentucky up to the same level of medical and dental care that the 16 Passport counties currently experience.
CHRISTOPHER C. BABCOCK,D.M.D, M.D.
Kentuckiana Oral and Maxillofacial Surgery