Unpaid medicaid claims threatens closure of Colfax clinic

COLFAX – “We can no longer accept Amerigroup patients.”

These seven words may seem like a minor inconvenience for Medicaid patients living in big cities across the nation. But for people in small-town Colfax, this sentence could mean the difference between access to local medical care or a potentially life-threatening situation.

“We have patients who are diabetic, who are hypertensive, who have heart issues. That leaves them with a complete cutoff of care ... a lot of them don’t have transportation to Des Moines or have health conditions that prevent them from traveling that far,” said Lisa Sytsma, Colfax Medical and Wellness nurse practitioner and owner. “These patients sort of become my family. I worry about them ... this is their home place to go. A lot of them feel pretty lost right now.”

In May, the staff of the medical clinic on North Walnut Street near East Howard Street informed their patients they will no longer be accepting insurance claims from Amerigroup, one of three companies responsible for managing Iowa’s now privatized Medicaid system.

According to Sytsma, the clinic has not received payments from the national managed-care organization since she took over the clinic in August of 2017 — resulting in $30,000 of unpaid claims.

According to Sytsma, the decision to no longer accept Amerigroup patients affected about 100 of their patients, or about 15 percent of the clinic’s overall clientele.

“A lot of those people are in Amerigroup because they can’t afford insurance. Maybe they are in there because of a pre-existing disability. Maybe they are not making enough money. Or maybe they have three children and are only making $20,000 or $30,000 per year. They don’t have a choice,” Sytsma said. “Say they go with a plan with the Affordable Care Act, a lot of those are high-deductible plans. They may pay $350 a month and still have a $10,000 deductible. ... They could easily rack up a bill $8,000 to $10,000 within a month by just continuing to come here.”

Sytsma said the clinic also lost about $12,000 after AmeriHealth left the Medicaid program in November.

She said the backlog of unpaid insurance claims and losing its Amerigroup patients could prompt the clinic to close its doors for good – shutting down the only health clinic in town.

It cost Sytsma about $18,000 per month to keep a Colfax clinic open. Missing $30,000 is a significant chunk of money.

“That is hard on a bank account when we don’t have the money coming in,” Sytsma said. “How are we going to buy our next vaccines, medications, (Depo-Provera) shots? ... If this closes, that leaves our staff without insurance, without money to care for our families.”

After posting a message about their situation with Amerigroup on their Facebook page, the community quickly jumped to their aid. Before long, State Senator Chaz Allen, D-Newton, and other community members began voicing their concerns to Iowa’s Department of Human Resources and Amerigroup.

After months of battling, the staff at the small town clinic said they have worked out a contract with Amerigroup.

“They saw what was on the news. That prompted them to call. I told them we called daily multiple times a day trying to figure it out. But as soon as we get on public TV, we find out these are all internal errors. The contract was just sitting there and no one was doing anything with it,” Sytsma said. “The person that we talked to has promised to make it right. So we are waiting.”

Amerigroup cited an internal error and told Sytsma the clinic would receive payments dating from February, still potentially resulting in loss of about $15,000.

“Right now, a lot of clinics, not just in Jasper County are getting slow played and they won’t be able to survive like that,” Allen said. “The MCOs were put into the state two or three years ago without the time to get the system set up so these small clinics can go out and get the appropriate billing records ... they have a clinic of (four) people in Colfax. They don’t have the back office to follow up on these things consistently. They are treating patients and doing their job.”

Sytsma said once they begin receiving payments, the clinic will then make the decision on whether they can resume accepting Amerigroup patients.

Allen said while he is glad Amerigroup is working on paying the Colfax clinic, he said small town clinics should not have to reach out to the public to resolve their issues.

“I’m disappointed that it is a process that MCU set up that makes this so hard to accomplish,” Allen said. “This is what happens when their is a media push. But it is unfortunate that clinics have to go through this to get what they are owed.”

The Jasper County Tribune reached out to Amerigroup for comment. The company did not respond to our requests by presstime Tuesday.

DHS released the following statement prior to Amerigroup settling on a contract with Colfax Medical and Wellness.

“The Department is working closely with the MCOs to ensure prompt and appropriate payment to Medicaid providers. While we’re hearing from providers that claims are being paid more timely, and the situation is improving, there may be some older outstanding claims that the MCOs are working to resolve,” the department wrote. “(DHS) will continue to monitor this and is committed to providing strong oversight of our managed care partners.”

Despite this small victory, Sytsma and Allen said their is still work to be done to prevent the Colfax clinic from closing.

“This has left a sour taste in my mouth and shows that we have to make some big changes to our Medicaid system in Iowa,” Sytsma said. “(Colfax) wants us here and needs us here ... all we can do is continue to fight to keep our small town clinic open.”

To contact DHS, call 1-800-972-2017 or visit dhs.iowa.gov.

For more information about the local clinic, visit colfaxmedical.com, call 515-674-9020 or find Colfax Medical And Wellness on Facebook.

Contact Anthony Victor Reyes at areyes@jaspercountytribune.com