Negotiations continue over health care plan

Published 6:00 am Friday, February 16, 2007

Negotiations are continuing between six local physicians and ahealth care agency following the physicians’ decision not tosupport the Windsor Medicare Health Plan of TN, Inc.

Earlier this month, Drs. Bryan Calcote, Paul Dykes, BraxterIrby, Dena Jackson, Charles Kergosien and Ray Montalvo Jr. publiclyannounced they would not be participating providers in the Windsorplan. Enrollees in the Windsor program are required to obtainmedical care from an in-network participating provider.

TN, Inc. is presently negotiating with the six physicians tobring them into the program, said Shelia Reed, a spokesperson forthe company. However, she was not privy to how those negotiationswere progressing and could not make a comment on the localsituation.

Subscribe to our free email newsletter

Get the latest news sent to your inbox

“We are talking with them and I’d rather not comment right now,”she said.

It is unlikely, however, that any of the physicians will changetheir minds about participating in the program, said OliveMcDowell, office manager at Southwest Mississippi Nephrology, whereIrby practices.

“It’s just not practical for us,” she said.

Attempts to contact other physicians were unsuccessful.

Representatives from TN, Inc. had visited the county recently tomeet with prospective clients both individually and at publicforums, such as churches. At least 250 policies were sold toLincoln County residents, Reed said.

McDowell said the Windsor program was no different than a HealthMaintenance Organization (HMO).

“We don’t have the time or personnel to participate in a HMO,”she said. “If we should participate with them, everything wouldhave to be pre-ordered and approved before services could beprovided.

“When you get into HMOs you get into a very complicatedsituation that we’re not equipped to deal with,” she said.

Francis Rullan, director of communications for the MississippiMedicaid Division, said the HMO system has traditionally notperformed well in rural areas because there are fewer doctors percapita than in an urban setting.

In large cities, he said, finding a participating doctor may notbe too difficult. But in a rural setting the nearest participatingphysician may be a 100 miles or more away, which would make usingthat doctor impractical.

In addition, McDowell said, the Windsor plan in particular hasconfused some of the local purchasers of the plan.

“It’s connected with Medicare, but you lose your traditionalMedicare benefits when you sign up for this,” she said. “It’s notwhat the patients think. Our patients think they’re taking out asupplement, but they’re actually dropping their Medicarecoverage.”

Rullan said people should be very careful in signing up foralternative or supplemental Medicare programs. He suggestedresidents consult their local Medicare representative about howadditional programs would affect their Medicare benefits beforesigning a policy.