WATER VALLEY – Prob-lems with the county’s healthcare coverage for the 60-plus full-time employees has been a recurring topic during the year.
The problem started after supervisors elected to switch health care coverage from Blue Cross/Blue Shield to Humana to generate an estimated $177,000 in savings this year. The savings is calculated as the monthly premium decreased in January per employee from $742.50 monthly with Blue Cross/ Blue Shield to $545.46 monthly with Humana.
One of the recurring complaints by county workers stems from services provided by Yalobusha General Hospital and the hospital-owned clinics in the county that have been billed separately.
This means that county employee’s co-pay does not cover some services including lab procedures when they visit Odom Rural Health Clinic in Water Valley or Coffeeville Health Clinic.
During the first meeting this month, supervisors put their insurance agent, Alan Tanquay, on the hotseat about the situation.
“Allen, the biggest concern I have is the fact that you are our go-between Humana and the county. We count on you to take care of problems when they come up. This problem has existed for over a year and it hasn’t gotten any better,” Board President Tommy Vaughn explained during the meeting.
“We expect our go-between guy to take care of these problems,” Vaughn added.
Tanquay explained the two clinics owned by the hospital are licensed as rural hospital clinics. Which means some areas in the clinic are designated as part of the actual hospital facility.
“They are telling me that they can’t bill it any different based on how their license is certified,” Tanquay explained. “What they are doing is correct, but it is not the normal way that physician clinics file their claims.”
After Tanquay’s explanation, supervisors questioned Yalobusha General Hospital Administrator Terry Varner about the billing process during a subsequent meeting held last Friday, Sept. 14.
Varner clarified the clinics are set up as provide-based rural hospital clinics, explaining services performed in the clinic are actually part of the hospital and billed out accordingly.
“Is there is no way to get around it?” Vaughn asked.
“No sir,” Varner answered.
Using this provider-based rural hospital model, Varner explained the hospital receives more reimbursement from Medicare or Medicaid. But the catch is the hospital cannot bill a private insurance less than what the federal government pays for services.
“What we don’t understand is this is the only hospital in the state that we have had this problem,” Tanquay added.
Later in the day Varner contacted county officials and reported he had found a way to bill the lab procedures through the clinic.
“It all worked out,” Varner told the Herald. “Since it is all under one tax ID number, one entity, the hospital will bill the clinic and the clinic can bill the patient,” Varner explained. Now the patient’s co-pay will cover the lab procedures, Varner explained.