Looking for medical aid

Brenna Rankin, 26, recently tried to find an eye doctor. Although it sounds simple, this is a frustrating task for someone who doesn't have insurance.

"I called, and there is only one (optometrist) who accepts Medicaid," she said Wednesday during a telephone interview from her Gardnerville home. "They said they'll call me and let me know if they can help me."

For Rankin, getting any doctor to pay attention to her is difficult. She has to seek out providers, and most of them don't have room on their crowded rosters for another Medicaid patient. Medicaid and Social Security are the only health coverage she has.

The state Medicaid office doesn't have a list of private doctors who take Medicaid patients because the list constantly changes. The patient must call each doctor to find out.

Rankin said Medicaid is frustrating because she can't choose her doctors. Rankin is in remission from childhood leukemia. She still has medical complications from the chemotherapy treatments and recently had gastric bypass surgery.

When Rankin needs to visit a general practitioner, she has to drive about 30 minutes to Sierra Family Health Services in Carson City, the only community health clinic in the area. She heard from her doctor there that the state Medicaid office is slow to reimburse doctors, which makes the doctors hesitate to take patients, or not take them at all.

"People need medical help, and Medicaid is making it really difficult for them to get it," Rankin said.

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It's mid-morning in the waiting room of Dr. Anthony Zimmerman, and all is quiet. The only sound comes from a tall toy aquarium which gurgles as little plastic tropical fish bob around the bubbles.

Zimmerman recently opened his own family practice, Rabbitbrush Healthcare. He worked at Sierra Family Health Services for about two years. Zimmerman said there is a problem with Medicaid because of the state.

"The state is reimbursing physicians slowly, incompletely or not at all," he said.

Zimmerman called around to many local family doctors and found that they aren't taking Medicaid anymore because they lose money. He said Medicaid will reimburse a doctor about $44 for an average patient visit, but that visit costs the doctor about $46.87.

"It costs him (the doctor) more in overhead to see the patient than what Medicaid is paying him," Zimmerman said.

Sometimes, specialty physicians will take Medicaid patients because the person has no other option.

"No one will let people who really need it fall through the cracks," Zimmerman said.

He recommends that uninsured people go to Sierra Family Health Services or the Ross Clinic at Friends in Service Helping. Several communities, such as Minden or Gardnerville, don't have community clinics. He believes this is a political problem that needs to change.

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Sierra Family Health Services is a federal-qualified community health center and part of a state nonprofit company. That means it gets a higher reimbursement for Medicare and Medicaid. The community health centers are reimbursed from the state for the full cost of the patient's care. A private physician or specialist barely gets enough back to cover his or her costs, said Steven Hansen, Nevada Health Centers Inc.'s chief executive officer.

Hansen said the center has had problems with Medicare reimbursements, but it has improved. If Medicaid wants to recruit more private physicians into the program, Hansen said, the state office needs to mend old wounds.

"Medicaid needs to go out and re-recruit physicians into Medicaid and earn their trust again," he said. "They need to go knock on doors and talk to providers. They need to say 'We'll pay you now. We won't take nine to 10 months to pay you.' And they need to give a higher reimbursement rate for specialty physicians."

Charles Duarte, administrator of the state Division of Health Care Financing and Policy, which oversees the Medicaid program, said the office did have a problem in late 2003 with reimbursements, but there hasn't been any major issues since. He said in one weekend the office sent out $60 million to practitioners and therapists.

"A lot of issues have been resolved," Duarte said. "We're paying someone because the money is going out."

Physicians who are not getting paid should contact the state office. He said it can also give cash advances for claims waiting to be processed.

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Not everyone is unhappy with Medicaid. Joe Whitworth, a retired chef, said his cancer specialist and regular doctor take Medicaid. Whitworth has lived in Carson City since 1939.

"So far it's been real good," he said while sitting at a table at the Carson City Senior Citizens Center. "I haven't had any trouble with it."

Whitworth doesn't know the intricacies of the Medicaid program, he just knows his bills are paid. But he doesn't get any drug discounts. Whitworth's right eye is swollen and sewn shut. Only a few days ago, cancer was removed from under it.

In about four months, Whitworth's cancer specialist will cut out the stitches and find out if he can see. Right now, his one brown eye directs him, that, and his good friend Berry Meyer. Meyer and Whitworth eat their lunches together at the senior center.

"The doctor thinks I'll see again," Whitworth said.

Contact Becky Bosshart at bbosshart@nevadaappeal.com or 881-1212.