Enloe, insurer part ways on home care

NURSE’S CONCERNS<br>Naomi Mojica is worried about Blue Shield subscribers, especially mothers and newborns, who will no longer be able to obtain home care through Enloe because of a contract termination.

Naomi Mojica is worried about Blue Shield subscribers, especially mothers and newborns, who will no longer be able to obtain home care through Enloe because of a contract termination.

Photo By Meredith J. Cooper

Naomi Mojica believes in the value of pediatric home care, especially post-birth visits for new babies and mothers. She laments that she will not be able to perform this service for Blue Shield insurance holders any longer.

The registered nurse is concerned that the termination of the contract between Enloe Hospital’s Homecare Services, where she works, and Blue Shield will hurt patients.

The Newborns and Mothers Health Act of 1997 guarantees a new mother an in-home visit at a physician’s discretion. Mojica says these visits are usually recommended for high-risk babies and that these services are crucial for healthy development.

“This is an important issue for pediatrics because the majority of new mothers [at Enloe] are Blue Shield subscribers,” Mojica said.

Some of the procedures done during home-care visits include mother and baby “well checks,” lab tests, breastfeeding assistance, and so forth. Doing them at home could actually save money by eliminating the need to visit up to four different medical facilities to do what Enloe nurses are capable of doing in one visit.

Mojica’s letters to the editor have been published, but they do little to explain the complexities of the insurance issue. The problem was that the hospital hadn’t received a reimbursement increase for home-care visits since 2004 and was losing money with each visit.

“Home care has never been a profitable service,” Mojica said. “But all we want is to break even and care for the patient.”

The contract termination means all Blue Shield customers, not just newborns and their mothers, will no longer receive Enloe home-care services.

“The whole demographic in home care, from the newborn to the 90-year-old, is affected,” said Terry Burgoyne, director of Homecare Services. “If they are covered by Blue Shield, we can’t help them.”

Enloe went to great lengths to come to an agreement and still welcomes the possibility of renegotiating a contract, Burgoyne said.

“At some point the Blue Shield people never responded to our request,” she explained. “We were in the process of negotiation, and they simply left the table.” Enloe had no choice but to terminate the contract.

“We just want to cover our costs, and Blue Shield was unwilling to even approach our cost of service,” Burgoyne said.

The problem, from Blue Shield’s perspective, was that Enloe’s costs were too high.

“The rates they were quoting were much higher than any of the rates we pay home health agencies we contract with in Butte County,” said Elise Anderson, media relations manager for Blue Shield. “We always look for financially competitive price coverage for our members.”

Anderson said Blue Shield currently has contracts with six home-care agencies—three located in Chico. No Blue Shield customer will go without service, she said, adding that Blue Shield is more than willing to reopen a contract with Enloe.

Laura Hennum, Enloe’s vice president of strategy, communications and marketing, recommends subscribers visit Blue Shield’s Web site to find out what services their policy covers. “For new moms in particular,” she said, “we are trying to be proactive and let them know that they need to check.”

Insurance is a huge ongoing issue in the American health-care system, Hennum added—"every payer source doesn’t want to pay as much for anything.”