July 15, 2005

TennCare policies outlined

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Thomas Catron, Ph.D.

TennCare policies outlined

Vanderbilt is taking steps to help those patients who have been notified they will be dropped from the state's TennCare program.

Earlier this summer, the thousands of adult TennCare enrollees who were targeted to be cut from the program were given a month to fill out an eight-page questionnaire that the state would use to make final determinations about eligibility. The deadline for returning the questionnaire was July 6.

In the weeks leading to the questionnaire deadline, collections staff with the Vanderbilt Medical Group business office called adult TennCare patients who are scheduled for surgery at Vanderbilt after Aug. 1 (when disenrollments become effective) or who are scheduled for five or more outpatient visits from August through December. The staff members offered these patients assistance in completing the state's questionnaire.

Many TennCare enrollees have since received their disenrollment notices, and have been given until the end of July to appeal. The VMG business office is setting up a hotline to assist appeals of disenrolled TennCare patients who are currently scheduled for surgery or for visits at Vanderbilt.

The VMG business office is hiring more financial counselors to assist with this process.

The VMG this week also released policies regarding how those disenrolled would be served.

Among the policies outlined this week are:

• Vanderbilt physicians will continue to care for those patients whose treatment cannot be obtained elsewhere.

• Physicians will arrange for the orderly transition of care if it is determined that patients can be adequately cared for elsewhere. In addition, they will assist patients in searching for other adequate care options.

• Future appointments that have already been scheduled will be honored and patients will continue to be treated at Vanderbilt if transfer to another provider would be detrimental or disruptive to their care.

• As is the case with any patient who does not have insurance, those disenrolled from TennCare will have to make a prepayment deposit prior to care unless the patient qualifies for a sliding scale of reduced charges or other financial assistance.

• Financial counseling will be available to help affected patients and their families.

VMG policy requires any patient without insurance to make a prepayment deposit prior to care.

For those unable to make deposits, financial counselors will be available to help determine patients' ability to pay or indigency status, and will help them work out reasonable payment plans based upon means.

New patients who are being disenrolled from TennCare — those who are new to Vanderbilt or new to a specialty for a new problem — will be told that they will have to bring the deposit with them to their visit in order to be seen. A schedule of prepayment deposits is being developed for each clinic and will be available online.