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Midwives, Others Having Trouble Getting Paid From Medicaid HMOs

Dixie Morgese leads a meeting in Volusia County.
Dixie Morgese leads a meeting in Volusia County.

Used to be, Marianne Power could sit down one night, do all of her own billing and get paid 10 days later. That was before Florida hired private insurance companies to manage its Medicaid program in 2014.

Power is a midwife in Lakeland, the area of Central Florida between Orlando and Tampa. She's been practicing for 17 years, and most of her patients use the Medicaid HMO program.

She's had problems since the transition to private companies managing Medicaid.

"We just kept getting denials and denials and denials," Power said. "We weren't getting paid. We had probably outstanding $15,000 in claims that were not getting paid."

The transition has been so bad, Power had to completely overhaul her billing system and hire a billing specialist. She blames the HMOs.

"They’re just nibbling away at the reimbursement to the providers," Power said. "And then the exponential increase in our overhead is just not sustainable. There are a lot of licensed midwives in the state who refuse to accept Medicaid any longer because of it.”

Obstetricians aren’t the only health care providers in Florida welcoming babies into the world. There are more than 200 licensed midwives in Florida, and they provide an alternative to traditional hospital births for healthy mothers.

Data from the Agency for Health Care Administration show payment complaints spiked nearly doubled from a low in December 2014 to last September.

The biggest spike started this past July – to more than 300 complaints per month. The state says complaints dropped since then, though, and that the complaints come from fewer than 1 percent of providers.

[caption id="attachment_54851" align="alignnone" width="400"] The rate of complaints per 1,000 Medicaid enrollees has nearly doubled.[/caption]

“Bills are sort of disappearing into the ether," said Allan Baumgarten, a financial analyst who studies Florida HMOs. He said the problem is most likely growing pains: Software glitches, issues with how claims are filled out, that kind of thing.

Baumgarten said smaller providers, like midwives, are easier for the insurance companies to ignore.

“Clearly a major provider like Florida Hospital or HCA is going to get the attention of those people whose job it is to sort of grease the process and make sure the providers get their check,” Baumgarten said.

When Florida lawmakers originally backed privatizing Medicaid in 2014, they thought it would save taxpayer dollars if private companies took over the management of care for 3 million Floridians.

Health care providers say there are issues. Claims are denied or delayed. When there’s an issue, it’s hard to get it resolved. And it’s not just midwives: Pediatricians and obstetricians are having trouble too.

Dixie Morgese recently led a meeting at the Volusia County Health Department. It's a group of health care providers and insurance company officials. They’re trying to find a way to make sure everyone gets paid.

In the front row sits Jennie Joseph, a midwife in Central Florida. She’s frustrated because she’s not getting paid from insurance companies. She puts it simply:

“That’s where we’re at: Drop off the Medicaid or close the practice," Joseph said. "That’s gonna happen.”

Joseph holds up her phone. She has a lawyer listening in on the other end.

“We don’t know what else to do or where else to go as far as what to do next," Joseph said.

Morgese asked the room: Any thoughts? No one responded.

The Florida Association of Health Plans, which represents the Medicaid HMOs, said in a statement that it’s committed to reimbursing providers in a timely manner.

“While contractual relationships vary from plan to plan, all of Florida’s health plans are committed to timely and effective reimbursement of providers," the group wrote in a statement.

And Baumgarten, the insurance analyst, has one bit of advice for providers: Contact the Florida Agency for Health Care Administration, and see if they can help get you paid.
Editor's note: This story has been updated to reflect new numbers from the Agency for Health Care Administration.