Tenn. Forum Highlights Health Plan Concerns

By Kristi L. Nelson, The Knoxville News-Sentinel, Tenn.
McClatchy-Tribune Information Services

Aug. 01--About 80 people attended a public forum Tuesday evening to tell Tennessee Commerce and Insurance Commissioner Julie Mix McPeak what health benefits were important to them.

The Knoxville forum was the third of six McPeak is holding around the state to help decide which health insurance plan should be used as Tennessee's "benchmark" for minimum benefits when part of the federal Affordable Care Act takes effect Jan. 1, 2014.

McPeak is tasked with recommending to Gov. Bill Haslam one out of 10 existing insurance plans available in Tennessee, chosen by the U.S. Department of Health and Human Services. She'll collect information through Aug. 10, then make a recommendation in September -- one that will also likely form the basis of health insurance exchanges to come later.

Most who spoke at Tuesday's forum, held at the University of Tennessee Conference Center downtown, were there on behalf of special-interest groups or service providers. Few recommended a particular plan among the options, focusing instead on certain benefits they hoped to see included.

One exception was Sarah Helm, who works in UT's Office of Career Services and has multiple sclerosis, an often-progressive neurological disease that can cause a host of health problems and disabilities, including severe pain and difficulty walking, speaking or controlling bodily functions. Helm asked McPeak to recommend the Preferred Provider Organization plan already offered to state employees, which she said paid for a two-week hospital stay, chemotherapy treatment and more than a year of outpatient therapy.

"The physical and occupational therapy allowed me to get my life back," said Helm, who has returned to work. "MS (symptoms are) so unpredictable. You have to expect the worst-case scenario" when looking at treatments to be covered.

Lawyer Douglas Nanney, speaking on behalf of Cornerstone of Recovery, which provides residential and outpatient substance abuse treatment, urged McPeak to make sure the essential benefit package the state uses as a benchmark includes residential treatment for addiction.

Nanney, who went through Cornerstone's program and is now an admissions counselor, said many people reach the point of seeking treatment only to find their insurance policies, while they may cover addiction treatment, don't cover the types of treatment that give them the best chance of getting clean.

Career Shop Benefits with FULL Independence

"The road is full of potholes, and we don't know where they are before we hit them," he said. Agreeing on a "benefit doesn't end the discussion."

Likewise, nurse practitioner Leslie El Sayad, vice president of the East Tennessee National Alliance on Mental Illness, asked McPeak to work on eliminating barriers that keep people from getting necessary mental health care, even as state and federal mandates already require insurers to offer certain mental health benefits.

"Recently, we've had so many denials ... people who are ready to seek treatment but don't meet the criteria," El Sayad said. "We shouldn't have to be spending half of every year down in Nashville fighting for benefits you say we already have."

Patti Johnstone, director of the audiology clinic for UT's Department of Audiology and Speech Pathology, said the state needs to clearly define insurers' responsibilities meeting the new benchmark. Johnstone said that although a hearing aid benefit for children has been mandated since Jan. 1, her clinic has yet to be reimbursed for hearing aids because the law leaves "ambiguity" that insurers "exploit" to avoid paying.

McPeak told Johnstone the state will investigate. She reassured a concerned teacher that the essential benefits package will cover child vision care, and told an autism advocate that she doesn't "see a lot of revision" to already-mandated autism benefits.

Other speakers expressed concerns about limits insurers put on durable medical equipment and prostheses, which McPeak said were not addressed at earlier forums in Nashville and Kingsport; on limiting coverage of prescription drugs to one per class of drug; and on covering preventive screenings and diagnostic tests.

"We definitely have to look at long-term cost versus short-term cost," said Lida Mayer, a volunteer with the Tennessee Health Care Campaign advocacy group. "We're often penny-wise and pound-foolish."


(c)2012 the Knoxville News-Sentinel (Knoxville, Tenn.)

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Distributed by MCT Information Services

01 Aug, 2012

Source: http://insurancenewsnet.com/article.aspx?id=352359&type=lifehealth
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