School and community-based health clinics are efficient and cheap, yet financial stability is still elusive. Private insurers don’t reimburse them for treatment, clinic administrators told lawmakers today, because the managed care companies don’t let the clinics into their provider networks. Is that because the clinics haven’t asked loud enough?
Mary Ellen Hass (center) listens as colleague Deborah Poerio (right) tells lawmakers about the benefits school based clinics.
Mary Ellen Hass runs Stamford’s school-based health center. Six years ago, the clinic billed private insurers roughly $35,000 for health services it provided to children, Hass told lawmakers at the state Capitol today. They got paid only $2,400, Hass said, because most private insurers don’t recognize school-based clinics in their networks. And of the $2,400, half went to a billing company, she said. That caught state Rep. Denise Merrill’s (D-Mansfield) attention. “You can’t contract to be a provider?” she asked.“No,” replied Deborah Poerio, representing the Connecticut Association of School Based Health Centers (CASBHC). Lawmakers and health care experts met today in the Legislative Office Building as part of Healthy Kids Connecticut, a forum convened by Speaker of the House James Amann (D-Milford). Their task is to come up with ways for the state’s 71,000 uninsured children to get quality healthcare. School-based health clinics and community-based clinics might be key components of meeting that goal. These clinics, found in cities and towns across the state, save the health care system dollars by intercepting patients before they go to the emergency room. For example, a child’s asthma attack treated in a school clinic costs $22, versus $350 in an emergency room, according to CASBHC. Roughly 30 percent of school clinics’ student patients are uninsured, according to Poerio. 28 percent are on private insurance. The rest are on Medicaid. That means the clinics must rely on grant funding from to pay for 58 percent of the budget. So if more private insurance included the clinics in their networks- and paid clinics to treat patients- that would go a long way towards making the clinics financially stable. The reason Medicaid pays clinics- and private insurance plans don’t- is because the state’s Department of Social Services forces managed care companies to reimburse school clinics. DSS has no such power over private insurance plans.Hass believes private insurance plans don’t recognize school clinics because the clinics treat so many patients, meaning the plans would have to pay out too much money. That would impact their bottom line. But private insurance plans have certain procedures for doctors or clinics wishing to join their networks, said Keith Stover, lobbyist for the Connecticut Association of Health Plans. Before the clinics “throw stones” at the industry, he said, they should make a real effort to join those networks.
Keith Stover, insurance lobbyist: Come and ask us.Stover said he didn’t know if school clinics would be positive of negative for the bottom line, but some plans, like point of service, would already pay for clinic care, even if it is out of network. “Insurance companies are not in the business of excluding providers for whom significant demand is coming from their members,” Stover said. “We haven’t had an instance of a school based plan approaching a managed care organization with data of high demand and been refused.“Even if the clinics were admitted to private networks, he said, they would then have to hire administrative staff to handle the paperwork, which would offset part of the money they would pick up.Stover said he would be happy to meet with clinic representatives to discuss the situation.
