Tell me if you’ve heard this one before: “Trust us, we’re with the health insurance company.” For patients and doctors, it’s a familiar refrain, especially when it comes to care for patients on Medicaid.
Oklahoma receives funding from the federal Medicaid program with the disbursement of funds flowing to physicians to reimburse the cost of treating Medicaid-eligible patients, including single mothers and their children, low income seniors and Oklahomans with a disability.
From 1996 to April of this year, Oklahoma managed its Medicaid program through “Soonercare,” which operated successfully under the purview of the Oklahoma Health Care Authority. Under Soonercare, patients were served and medical claims were processed quickly, with the vast majority being processed within 24 hours.
In fact, a 2022 review of Soonercare found that our state’s Provider Error Rate Measurement (PERM), a rate that measures how accurately states process Medicaid claims and determine eligibility, had an error rate of only 1.95% - placing Oklahoma at second best in the country and well below the national error rate of 15.62%.
In short, Soonercare wasn’t just working – it was best in class. Oklahomans who needed care were receiving it, and physicians who provided the care were being reimbursed for the work.
Our Medicaid program wasn’t broken, but that didn’t stop Kevin Stitt from trying to “fix it” anyway. And how, you might be asking, did he propose to fix our best in class program? By handing the program over to insurance companies — privatizing a well-run state government program.
Yes, really.
It was still the governor’s first term in office when he forced the Oklahoma Health Care Authority to issue contracts to four health insurance companies to “manage” our state’s Medicaid dollars.
The first time around, the governor did not even seek legislative approval for the more than $2.1 billion in new contracts for his insurance company cronies. Challenged legally by physicians represented by the Oklahoma State Medical Association and others, the contracts were ultimately voided by the Oklahoma State Supreme Court, which ruled in June of 2021 that the State Constitution gives the legislature sole authority over budget allocations.
Not to be detoured, Stitt went back to the drawing board, pitching his insurance company healthcare takeover to legislative leaders until he ultimately got his way in 2022, when the legislature passed a new managed care plan that promised timely response and an easier process for patients and physicians alike.
The slow-motion shipwreck that ensued was entirely predictable. Since Oklahomans were forced to transition to managed care in April of this year, here’s what’s happened just in my office: My office manager now spends hours a day on the phone appealing to “representatives” for the managed care insurance companies, who routinely deny things as simple as a urine analysis — something we do at every appointment during a woman’s pregnancy to monitor the health of a mother and her unborn child.
For the services that are approved, our reimbursements from the insurance companies have arrived slowly or not at all, in a way that would be comical if it weren’t potentially devastating to my medical practice. As an example, reimbursement checks for my office in Norman have routinely and without explanation been mailed to South Carolina. By the time they are re-routed to my address in Norman, the checks have been voided, and the managed care companies told my office manager they would reissue the check with the correct address. When the checks were reissued, the checks were again mailed to South Carolina.
And I’m not alone. Ask any provider, from obstetricians to behavioral health practitioners, and you’ll find similar stories.
Physicians are being forced to take out loans to make payroll — all while the managed care companies are earning interest on millions of dollars earmarked to treat Oklahomans.
Prior to the passage of the 2022 law that mandated managed care in Oklahoma, a coalition of health care providers called on the governor and the legislature to stop the managed care shell game before it started. Our warnings were dire: physician offices would be forced to close their doors as insurance companies rationed care and denied claims in the name of protecting their own profits.
A mere five months into the new program, and insurance company controlled health care is bad and only getting worse. It’s time for Governor Stitt and the Oklahoma Legislature to undo this debacle. If they don’t, physicians will be forced to close their doors or stop seeing Medicaid managed care patients, and Oklahomans, particularly in rural parts of the state where medical care is already scarce, will suffer.
The governor must stop this health care holdup and put an end to insurance company managed care – once and for all.
Editor’s Note: Steven Jimerson, MD, is an obstetrician gynecologist in Norman with more than 50 years of experience treating patients. He is also a member of the Oklahoma State Medical Association.
