Wellmont reconsiders, will join CoverTN

Rick Wagner • Feb 26, 2007 at 11:09 AM

Wellmont, MSHA won't participate in CoverTN; patients may not be covered at most Northeast Tennessee hospitals


Wellmont Health System will participate in the CoverTN program after all, but Mountain States Health Alliance is still opting not to participate.

Wellmont, a regional health system based in Kingsport, announced Monday afternoon it has notified state officials its hospitals would participate in CoverTN, Gov. Phil Bredesen's new plan to provide basic health care coverage to individuals who couldn't otherwise afford it and are ineligible for TennCare, Tennessee's version of Medicaid.

Neither Wellmont nor MSHA met a Feb. 15 to sign up to accept CoverTN.

Wellmont and state officials maintained consistent discussions for several days, and the talks came to fruition Monday afternoon, a Wellmont release said. The state plans for CoverTN to be up and running during the first quarter of 2007.

"Governor Bredesen has a good intention here, and he's trying to make health care open to all Tennesseans," Jack Lipomi, chief operating officer for Highlands Wellmont Health Network, Wellmont's physician-hospital organization, said Monday.

"It's important to reach out to help those who need this coverage," Lipomi said in the release. "Although there's much to be learned about this project, we are in as partners with Governor Bredesen, the state and the previously uninsured Tennesseans who will benefit from this initiative. Going forward, we'll continue to evaluate the program as it grows to learn more about its effectiveness in contributing to a healthier Tennessee."

Lipomi said the program has a 90-day opt-out for hospitals, but Wellmont plans to stay.

"We don't want East Tennessee left out of the program. We hope Mountain States joins up in the program," Lipomi said.

CoverTN is part of the governor's five-part health coverage plan called "Cover Tennessee." The other four portions are CoverKids, providing comprehensive coverage for children; AccessTN, providing comprehensive coverage for "uninsurable" adults; CoverRx, providing affordable medication to low-income and uninsured residents; and a project on diabetes and coordinated school health, focusing on disease prevention.

CoverTN would provide basic health coverage to any Tennessean who has been without health insurance for at least six months in a row. Employees and employers will pay into the program.

Marvin Eichorn, MSHA's senior vice president and chief financial officer, said CoverTN would reimburse about 60 percent of what it costs the hospital to provide care for enrollees, which is about the same rate as TennCare. The difference, Eichorn said, is in the duration of the benefit, with TennCare covering a person as long as he or she was on the program.

According to state documents, the options offered under CoverTN would cover $10,000 or $15,000 of hospital expenses, depending on which plan a patient chose.

"A week or so, and that benefit is gone, and it's gone until the renewal date of that policy," Eichorn said. "In a way, it's not even insurance."

Lipomi said Wellmont officials share the concern, adding that Wellmont lost $20 million last year in TennCare and another $16 million in charity care for the uninsured.

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