After a two-hour hearing in federal court, managed-care firm CoventryCares agreed to keep paying Appalachian Regional Healthcare for treating Medicaid patients at its hospitals through at least June 30 while negotiations continue. “Coventry officials said the state allowed another managed-care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry,” the Lexington Herald-Leader reported. “Blaming the state, Coventry had notified ARH that it was going to terminate its contract. About 25,000 Medicaid recipients in the ARH service area would have been affected.”
ARH then sued Coventry in U.S. District Court and asked for an injunction to continue coverage, which Coventry had said it would end May 4, the same day the hearing was held. The state ordered it to maintain coverage for 30 days, and Senior Judge Karl Forester ordered ARH and Coventry to negotiate.
After last week’s hearing, the adversaries and the state all said the goal was for patients to continue receiving care through Appalachian Regional Healthcare’s hospitals in Whitesburg and elsewhere in eastern Kentucky on “a long-term basis,” the Herald- Leader reported. “If the health care chain and Coventry reach an impasse, cabinet officials said procedures could be expedited with Coventry’s cooperation. That would allow Coventry members to switch to another insurance provider and continue receiving services at ARH.”
“The important thing is that ARH patients are going to be taken care of and people have access to care,” ARH attorney Steve Price said.
Coventry is one of three companies that provide managed-care services to poor, disabled and elderly people in Kentucky under Medicaid. “The state adopted that system last year in an effort to save money, but there have been complaints all around,” the Herald-Leader said.
Coventry officials said the state allowed one of the other managed-care providers not to include ARH in its network, which meant a lot of higher-risk, highercost patients ended up covered by Coventry.
Coventry attorney Lisa English
Hinkle said Coventry’s costs of providing services to eastern Kentucky patients have been much higher than projected. The company pays out $1.20 for every dollar it receives under its contract with the state, Hinkle said during the hearing, a situation she said was “not sustainable.”
Coventry is one of two managed care firms ARH has sued. ARH charges that CoventryCares and the other firm, Kentucky Spirit, owe $18 million for services ARH has provided to Medicaid members covered by the two firms.
ARH also has hospitals in Harlan, Hazard, Hindman, McDowell, Middlesboro and West Liberty, as well as three in West Virginia.
In a related matter, Pikeville Medical Center said its relationship with Coventry remains secure.
PMC’s agreement with Coventry has been in effect since Jan. 1, 2012. The hospital said all Medicaid patients are accepted at the medical center, as it also maintains agreements with the state’s other two contracted Medicaid managed care companies, Kentucky Spirit and WellCare of Kentucky.
“Our goal at Pikeville Medical Center has always been to provide the people of this region with ease of access to quality health care in a Christian environment,” said PMC President/Chief Executive Officer Walter E. May. “At Pikeville Medical Center, the patients come first. We certainly don’t turn patients away. Instead, we strive to make it easy for them to receive the best health care possible, close to home. We want to assure those with concerns that PMC has agreements with all three Medicaid providers and that we accept all Medicaid patients, regardless of their provider. We are here to care for you and your families.”
PMC Chief Operating Officer Juanita Deskins added, “The recent news headlines pertaining to Coventry no longer being accepted by several local hospitals has been alarming to the thousands of people affected. If you are one of these patients, Pikeville Medical Center wants to remove any concerns you may be experiencing by stressing that you do have a place to come for quality health care. Our doors are always open Coventry Medicaid patients.”
This report was compiled in part by Kentucky Health News, an independent service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.