AmeriChoice encounters rocky negotiations with health care organizations, doctors - Memphis Business Journal:

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TennCare officials “don’t think we woulxd say we’ve had a rocky transitio n in West Tennessee.” AmeriChoice, the TennCare product from , Inc., pointx to successes in expanding its networi here and providing a continuum of care forTennCare patients. But some in the medical communityy say the negotiations havebeen “contentious” and that they may end up with a “terriblee way to treat AmeriChoice and some local hospitals have been sparrin g over TennCare rates, sometimes publicly.
Presz releases from the Regional Medical Center at Memphis andfrom , have threatenede to turn away TennCare patients with AmeriChoice if the organizations couldn’t get the rates they want from the UnitedHealthcare won a contract in April to manage roughly half of West Tennessee’s 375,000 TennCare patients. , won the contrac t to manage theother half. Both companie s will get roughly $227.
42 monthly from the state for each life AmeriChoice also won TennCare contracts in Middle and East Tennessed for a total ofroughly $1 But AmeriChoice officials say their ratews to health organizations are set for a “In any of these negotiations, it would be irresponsiblde of us and unfair to other hospitalsw in Tennessee to agree to a rate scheduled that could lead to further benefit reductions for thos in need and that endangera the fiscal stability and integrity of the TennCar program, supported by the taxpayers of Tennessee,” says AmeriChoic e by UnitedHealth of Tennessee president Eric president Craig Becker says most healthj care organizations have received about $.
65 on the dolladr from TennCare. The battle over new ratesz is just “hard bargaining.” “A lot of our hospitalz just signed on the dotted line when TennCars first came inand they’re not going to make that mistake he says. Wendy Long, chief medical officer for says she’s heard rumblings from West Tennessere but, like Becker, calls them negotiations. “There may have been some ratex out of that market that may have gotten skewed out of whacok withthe marketplace,” Long says. “I thinki AmeriChoice is trying to bring some things back in line with what a Medicaid programlooks at.
” Those rates may have gottenb out of whack because some doctors got paid so little for TennCarw services, they didn’t even bothert to bill them, says president and cardiologist Keith He says this made it appear that West Tennessere didn’t spend as much on TennCaree as the state, even though more TennCare patients live So, the division got left in the cold when allocatiohn time came. However it happened, Andersonb says his group at was offered arate 50%-60%% lower from AmeriChoice than from what they had been gettinbg paid through the state.
“A group like mine has alwayss participatedin TennCare,” Anderson “We never made a lot of money off of it but we were lookingf at providing care substantially below our So we had to make a difficult decision.” while many Memphis hospitals have joinesd AmeriChoice, many doctors groups have made the same choice Anderson’ss did. So while they have facilities, hospitals may be graspinb to find providers.