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. She’s been practicing for 17 years, and most of her patients use the Medicaid HMO program.
She’s had problems since Medicaid transitioned to managed care.
“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."
In Florida, there are more than 200 licensed midwives who provide an alternative to traditional hospital births for healthy mothers. But Power said many are frustrated with how slow the payments are coming.
"There are a lot of licensed midwives in the state who refuse to accept Medicaid any longer because of it,” she said.
Data from the Agency for Health Care Administration show complaints 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.
In a statement Thursday, ACHA said the number of complaints coming from health care providers accounts for less than 1 percent of all complaints.
“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, such as 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 say they are having trouble too.
Dixie Morgese recently heard such complaints at a meeting she led at the Volusia County Health Department. It’s a group of health care providers and insurance company officials who are trying to find a way to make sure everyone gets paid for the health care services they provide.
In the front row of the meeting sat Jennie Joseph, a midwife in Central Florida. She’s frustrated because she’s not getting paid from insurance companies. She put 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 in the crowd responded.
The Florida Association of Health Plans, which represents the Medicaid HMOs, said in a statement that it is 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 officials at ACHA, the state agency overseeing managed care, and see if they can help get you paid.