Medicaid: Doctors Threaten Cutoff in Puerto Rico

Nearly 1 million Puerto Ricans could be affected if doctors make good on the threat.

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Doctors are threatening to withhold services from Medicaid patients. (Google)

Danica Coto of the Associated Press is reporting that physicians are threatening to stop serving nearly 1 million Puerto Ricans as a result of a dispute between the island's government and an insurance company over reimbursements for treating poor people.

Gov. Luis Fortuno on Wednesday appealed to the doctors to avoid cutting off patients, saying that it would be illegal. In an interview with WAPA, a local TV station, he also said that the government would withhold two months of payments to the insurance company unless it settled with doctors, hospitals, laboratories and others.

Just hours after Fortuno spoke, the island's health secretary announced that the government paid $57 million of the $87 million it owed Medical Card System Inc. for June. Secretary Lorenzo Gonzalez initially said that the remainder would be paid only when MCS settled its bills with medical providers, but he later said it would be paid in upcoming days.

"The money is and has always been available," he said. "Our concern has been to address the complaints of providers."

Physicians say that MCS owes them as much as $60 million. They plan to decide soon if they will stop stop seeing Medicaid patients until they get paid, said Dr. Joaquin Vargas, president of the Independent Practice Association, which represents 38 medical groups. "If this payment does not occur, the services will be threatened," he said. "It is a painful situation for us."

MCS President Jose Duran said in a statement that the company will start paying providers starting Friday, but he did not specify how much of the pending debt would be paid.

The standoff began shortly after the government launched a revamped Medicaid program in October, promising patients extended hours, more access to mental-health services and fewer preapprovals required to see specialists. The program caters to those who make less than $800 a month and to the disabled.

Amid reports of not paying providers, the government announced plans to terminate the $810 million contract with MCS, the largest insurance provider under the revamped program.

Wow, this situation sounds ridiculous. As usual, when those in power don't have their stuff together, it is the people who need help the most who suffer. Poor people deserve better treatment than this, especially when their lives are at stake. Doctors threatening patients is unconscionable. Perhaps they should try threatening the insurance-company executives, since they are withholding the money. The empowered stakeholders -- i.e. government, MCS and hospitals -- need to work it out and leave poor people out of it.

Read more at Yahoo News

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