Printer-friendly format

When Cover Tennessee began enrolling clients into its various programs in March, there was some concern among the state’s ob-gyn practitioners that TennCare patients they were seeing might be shifted to one of the new programs.

At the same time, some hospitals reportedly were not taking CoverTN and AccessTN’s expectant mothers because of delays in contract finalization for reimbursement and other issues.

But, according to officials with Cover Tennessee and TennCare, pregnant women on both programs are receiving full coverage for themselves and their newborns, and there is not, nor will there be, any shifting of populations between the two.

“If a woman is in the TennCare program, she does not have to move to CoverTN or CoverKids,” said Marilyn Wilson, communications director for TennCare. “In fact, federal law states that if she qualifies for Medicaid, we have to keep her in TennCare. CoverTN and CoverKids are not Medicaid products, so they would not be moved. We will not be moving anyone in TennCare who qualifies for Medicaid into the new products.”

CoverTN, AccessTN and Cover Kids, as well as CoverRX, were set up under the umbrella of Cover Tennessee to complement the state’s TennCare offerings, not replace them, she added.

“A woman would want to be tested first to see if she qualifies for TennCare,” Wilson explained. “It’s an entitlement program and is more comprehensive. But it’s for people who are living in poverty or are close to that, or are disabled. Most of our enrollees are children because the income requirements are higher for them than for adults. But overall, the populations we and Cover Tennessee serve are very different.”

In fact, even though Cover Kids is designed for children 18 and under, it’s also open to pregnant women who qualify, said Dean Flenor, public information officer for Cover Tennessee.

“In CoverKids, the program that covers pregnant women who are referred into it is Healthy Tennessee Babies,” Flenor said. “That provides maternity benefits.”

Women who are between 185 percent and 250 percent of the federal poverty level are eligible for coverage under CoverKids and the healthy baby program, while those who are below 185 percent of the federal poverty level would be directed to seek TennCare enrollment for prenatal, labor and delivery coverage, he said.

Healthy Tennessee Babies provides prenatal care, labor and delivery, and postpartum benefits, as well as practitioner office and inpatient hospital services. Following that, the enrollee would be moved back into CoverTN and the child would then be enrolled in CoverKids.

And while all of Cover Tennessee’s insurance programs have a “go bare” provision, which requires that the individual has not had insurance in the previous six months, that’s waived for newborns up to four months, Flenor said.

Both Wilson and Flenor stress that TennCare and the various Cover Tennessee products are not interested in funneling clients to one another, but will serve as entry points to help people ascertain what coverage they’re eligible, or not eligible, for.

“We do try to work together, and TennCare has tried to be a valuable resource for Cover Tennessee as they have developed their eligibility criteria,” Wilson said. “We want to be as helpful as we can to them from a referral standpoint, but we’re not going to be shuttling eligibles from one program to another.”

The programs also have entirely separate billing structures, so physicians participating in one or both will not be dealing with the same bureaucracy when it comes to filing paperwork. Cover Tennessee’s billing and provider networks are being provided by BlueCross BlueShield, which won the contract, while Amerigroup and AmeriChoice continue to be the managed care organizations for TennCare.

While it’s still early, and there may be some initial confusion among providers who are attempting to see patients in the old and new programs, so far it hasn’t been much of an issue for some hospitals.

“We’re not hearing of any major problems,” said Kristi Gooden, spokesperson for Baptist Hospital in Nashville. “Cover Tennessee is such a small percent of the population now, we just haven’t had a lot of them come through yet.”

Baptist is signed up to participate in both Cover Tennessee and Cover Kids, as well as TennCare, so it will be seeing patients across the state-care spectrum, but Gooden says she thinks the systems are being set up so that there won’t be too much confusion about which provider is responsible for what.

“Every system is different, and hospitals who have signed up for one program but not another may have some problems,” she said. “But I think we’ve got a good understanding here of which programs are covering specific areas, such as pregnancy and delivery, and we don’t anticipate a lot of problems.”


July 2007

Tags:

None