Ombudsman says most KanCare concerns are being resolved

0 | Legislature, KanCare, Medicaid-CHIP

— Kancare Ombudsman James Bart today assured members of the Senate Public Health and Welfare Committee that he’s been able to resolve most of the 74 complaints that have reached his office since it opened on Jan. 2.

“It’s been pretty hectic,” he said, “but I’ve been able to clear my emails and my voice mails every day.”

Bart said he’s heard from 46 consumers and 28 providers.

Almost 95 percent of the concerns raised by providers and 89 percent of those raised by consumers were resolved within a few hours or days. The remaining issues, he said, were in the process of being addressed.

“On the consumer side of things, there are still a lot of folks who don’t realize that the state is still in charge of determining (Medicaid) eligibility,” Bart said, noting that he’s helped expedite information exchanges between the Department of Children and Families and the KanCare managed care companies.

“The number one concern among providers,” he said, “is ‘whether I’m going to get paid on time.’”

But the insurance companies, Bart said, appear to be processing the providers’ billings in a timely manner.

Bart said he’s also been hearing from consumers who have learned that their primary care physicians are not in their managed care company’s networks. Many consumers, he said, assume that that means they should switch to whichever company’s network includes their physician.

“There is apprehension among consumers that because ‘Provider X’ is not in their network today, that they are not going to be in network in the future,” he said.

But that may not be the case, he said, because providers still may be in the process of signing on with the other managed care companies. Providers can be in the networks of all three KanCare companies.

Bart said he’s been reminding consumers that for the first 90 days of KanCare, which began Jan. 1, they’re free to continue seeing doctors who are outside their managed care company’s network. In the meantime, he said, “as the dust settles,” their providers may sign with the network they’ve been assigned.

“Just because a provider is not in the network today doesn’t mean they have to switch to another carrier unless they feel that’s necessary,” he said.

KHI News Service coverage of KanCare

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