Medicare confusion with two Tulsa hospitals

More confusion over Medicare coverage involving two Tulsaâ€™s hospitals, St John and St Francis. <br/><br/>News on 6 reporter Jennifer Loren has been working to get to the bottom of what has become a

Thursday, March 23rd 2006, 10:14 am

By: News On 6

More confusion over Medicare coverage involving two Tulsaâ€™s hospitals, St John and St Francis.

News on 6 reporter Jennifer Loren has been working to get to the bottom of what has become a serious health care crisis for many people.

The issue began when St. John and St. Francis took out full page ads in a Tulsa newspaper on Tuesday, letting people know they will no longer accept health care plans from Humana, Sterling and Secure Horizons Direct. That has seniors asking, what now and why?

Thursday, whether good or bad, we have some answers for them.

65 year old Phyllis Crims is diabetic and on a fixed income. She used to get her insurance through Community Care which is owned by St. John and St. Francis. But she says they wouldn't pay for her insulin, so she switched to a company new to Oklahoma, Sterling, who does pay for it. "The plan looked real good to me."

Phyllis has been going to the same doctor since 1964. She says he is the reason her health has improved recently. So when she heard he would no longer take Sterling, she was faced with a difficult decision. Find a new doctor or a new health plan. All of this with no warning. "With me that means I have to go to somebody and start all over again."

This same scenario is happening to seniors all over the Tulsa area. When they call to find out why, they get the same answer. Their health care plans are not paying the hospitals 100% of Medicare costs.

In a statement from St. John Hospital, they say "participating in these plans would place a significant financial strain on our system, beyond what we can responsibly bear." This begs another question. Phyllis Crims: "If they're not paying their bills nationwide, why in the world hasn't somebody sat on them?" The companies insist they are paying, even if it's the bare minimum.

So the News on 6 wanted to get to the bottom of this. St. John administrators finally agreed to meet with the News on 6, although not on camera. Administrators at St. John are sticking to their guns. They say these companies are not paying as much as Medicare pays. But they say, for themselves at St. John and not St. Francis, they will continue to allow their patients to use those plans until the May 15th deadline. And they say they did provide those companies with warning.

In these letters dated February 27, they tell them that they reserve the right to refuse patients enrolled in their programs. They say the companies are the ones who didn't warn their patients.

The News on 6 never heard back from St. Francis, but we did hear from the State Insurance Commissioner.

She told the News on 6, these companies are paying a legal amount under Federal law. But she says she is concerned about the way the company is selling the plans to seniors. That's why she is currently investigating them.