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Managed Care Coverage Criticized

January 13, 2013
The Intelligencer / Wheeling News-Register

Editor, News-Register:

As a tax payer and physician caring for patients with various insurances, I wanted to make the public aware that they are being short changed by MCOs which are getting into the health market stating that they are here to save the state of West Virginia money.

For those of you who do not know what an MCO is, it stands for Managed Care Organization. Residents of West Virginia are now being offered either traditional Medicaid or MCO Medicaid policies. Unbeknownst to me and I am sure many other West Virginians, those enrolled in an MCO will likely receive less medical benefits and procedures while the MCOs rake in more profit. In effect, we the tax payer as well as the Medicaid recipient are getting less bang for the buck, so to speak.

This is happening because Charleston created loopholes that allow MCOs to deny participants certain procedures as well as access to health care, while if those same patients were in traditional West Virginia Medicaid, they would receive that benefit. Procedures which are currently aproved by Medicare and traditional Medicaid can be called "experimental" and not allowed by an MCO, which would be offered to the patient with traditional Medicaid or Medicare.

MCOs are not saving the tax dollars we as citizens of West Virginia send to Charleston, they only deny their patient's procedures and end up pocketing the money denied for the care and profit from refusing the care!

We need to stop this obvious discrimination of health care and get our money's worth, especially if it is supposed to be directed at our less fortunate residents!

I call it mangled care, not managed care!

Roland F. Chalifoux Jr., DO

Board certified neurosurgeon and board certified interventional pain physician

McMechen

 
 

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