Letters: Managed care: Not all bad?

Wednesday, May 25, 2011

We went through a similar situation here in Hawaii when the entire state Medicaid fee-for-service membership was either enrolled or assigned in one of two managed care programs set-up here in the state ("New Jersey: State moves toward managed care," April 2011).

The provider networks were set up  here to be much of the same as it was under fee-for-service, so that part was not too difficult. We did have enough time to work on contracts, so that fortunately went well.

Both of the contractors were part of a national payer and set up as a subsidiary to do business here in Hawaii. The contract between them and the state of Hawaii was set up so that the reimbursement was the same as what it had been under fee-for-service, so that sounds better than what New Jersey appears to be trying to do. As a national company we are unfortunately getting paid a bit less on some items as the pricing for us is tied to the national contract with the parent company. So due to no fault of the new managed care, we do get a little less on some of the DME items than we did before or even what other providers are getting now.

Thanks for the informative article and your continued insights into the HME industry though your newspaper.

-Joseph Sunderland, customer service supervisor, Apria Healthcare