Dog-gone health care

By Thomas Wilson
STAR STAFF
twilson@starhq.com

   Shannon Hale's cocker spaniel, Buff, knew something was wrong.
   Hale's leg was swollen and bruised from recent surgery to repair a broken bone near his knee. Buff pawed, probed and even barked at the knee as if trying to force some unseen object out.
   In a matter of days, a blood clot broke loose from Hale's leg and traveled to his lungs. His family rushed him to the hospital where massive doses of blood thinners dissipated the clot. Hale, 24, of Hampton is facing a new problem related to his health.
   The most difficult problem, Hale says, has been finding a primary care physician willing to accept him as a patient. He has no insurance and is awaiting eligibility for TennCare.
   "I think its funny thing no doctor will take me," he said.
   Hale says he worked full-time at the Sand Trap restaurant in Elizabethton for two years prior to his injury, which occurred in April when he took an awkward fall at a local business. He did not have insurance through his job. Hale applied for TennCare through the state Department of Human Services shortly after the accident. However, he still has not heard about his acceptance into the state's health care program.
   The time leaves Hale without a primary care physician to review his condition or any ability to pay his medical bills, which stand in the thousands of dollars.
   Shannon's father, Terry Hale, says his son must go through the Sycamore Shoals Hospital emergency room to get treatment and medication to treat his leg.
   "He has to go every two weeks to get tested," said Terry Hale. "All he's got is the blood thinners, he can't afford the other medication. We still have to go to the ER to get blood work done."
   The problem, says Shannon's father, is physicians refuse to see him without insurance or cash payment in hand. He says no primary care physicians will take him as a patient because he doesn't have insurance. "If you have cash, they'll see you, otherwise forget it," adds Terry Hale.
   Despite the spending and politicking of the state's TennCare program, citizens continue to fall through the cracks of the health care system.
   TennCare is the state's managed health care insurance program for 1.4 million Tennesseans who are poor, disabled or uninsured. The state contracts with 9 managed care organizations to provide insurance coverage. The Bureau of TennCare permits enrollment to any applicant who is both below 100 percent of poverty and medically eligible.
   "TennCare has a lot of problems," said Steve Hopland, chief executive officer of Medical Care on West Elk Avenue in Elizabethton. "The biggest problem is, they cover too many lives." Hopland said uninsured patients once represented a large portion of the practice's business. Now, Hopland says, insurers have arranged payment rates with health care providers that effectively punish uninsured patients who paid costs out of their own pockets. "It is hard for anyone who doesn't have insurance to pay $100,000," he said.
   He added Medical Care had seen an influx of patients from at least one neighboring county saying they could not find primary care physicians that would accept TennCare. He says Medical Care physicians did not refuse to see patients with TennCare, but he said the practice did refuse some TennCare providers because of financial instability of the insurers.
   "We don't want to treat a patient if we can't take care of them all the way," he said. "Most people are willing to see if they are willing to pay their bills.
   Hopland points out that medical specialties such as urology and orthopedics often send patients as far away as Knoxville to comply the preferred providers of their insurance plans.
   TennCare Director Manny Martins announced in April the Bureau would terminate its contract with Universal Care of Tennessee effective June 1. In a written statement, Martins said the termination is the result of concerns about a range of management issues related to Universal Care, including questions about the company's net worth, delays in claims processing and unauthorized transfers of funds to an affiliated company.
   With no income and possibly weeks of waiting before learning of his TennCare status, Hale wonders how his future medical care will be delivered.
   "You couldn't think," Hale said, "a single fall would change your life."