Emory Report

April 3, 2000

 Volume 52, No. 27

HR addresses health care

By Eric Rangus

Three representatives from the Emory Clinic discussed the University's new healthcare system and its associated problems at the March 22 Human Resources representatives meeting in the Winship Ballroom.

Rein Saral, director of the Emory Clinic; Penny Castelano, director of primary care, and Paul Hammonds, chief administrative officer, addressed concerns and answered questions for more than an hour concerning administrative problems encountered by Emory employees.

"The good news is we've been working with Aetna and CIGNA to make some changes, and it looks like we'll be able to do some things with both plans," said Alice Miller, vice president of Human Resources, in her introduction.

One difficulty with EmoryCare is that CIGNA has not published an accurate and comprehensive directory. That led to Emory employees having claims denied because CIGNA did not know which doctors were part of the plan. CIGNA has promised to publish a directory by mid-April, according to Miller.

Miller also outlined a problem with access to mental health services. She said the plan's administrators, Aetna and Magellan, were under the impression that only the 14 Emory Clinic physicians were part of the plan; the plan was intended to include more than 200 physicians, the great majority of which were outside the clinic. Miller met with Aetna and Magellan, outlined Emory's original vision of the plan, and the problem has since been remedied.

Miller also discussed efforts to keep prescription drugs affordable and said the insurance companies do not have a financial incentive to deny coverage, since they are paid with a flat rate. She then turned the floor over to the three clinic representatives.

Saral said the clinic sees one million people a year and that the insurance industry's lack of uniformity makes things incredibly complex. The clinic deals with dozens of vastly different insurance plans--not just Emory's--and the administrative efforts to properly handle them all are massive. He said feedback is essential so that the clinic can focus on problems and make things better.

Concerns voiced by attendees covered a wide range of issues. They included:

  • referrals (Castellano said that a tremendously increased workload at the front end of the referral process has slowed the entire procedure. Hammonds said primary care arranges appointments for employees for their referrals, and committees are looking at automation and streamlining the referral process.)
  • claim denial,
  • scheduling difficulties (the clinic recently added staff to help alleviate the problem of getting people appointments in a more timely manner. Things have improved, according to Castellano and Hammonds, but the situation is still a little short of ideal.),
  • multiple co-pay charges (a common problem that should not happen and is being worked, according to Miller),
  • visits to in-network physicians charged at out-of-network rates (a system problem that has been addressed), and
  • delays in callbacks from doctors or nurse practitioners (the clinic realizes that barriers are slowing the process down and is investigating).

"We're making progress, it's not perfect," Hammonds said. "But this the most committed group of physicians I've ever worked with. And they want to do the right thing."

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