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Privatizing Utah's Children's Health Insurance Program (CHIP) is supposed to save money and improve services.
But with no proof yet of any savings reaped, the experiment has been tripped up by service breakdowns.
The latest: Complaints from some of the 379 CHIP families in Carbon and Emery counties who say their children no longer have access to pediatric care. That's because Intermountain Healthcare's SelectHealth, which inherited some CHIP patients on July 1, has no primary care doctors in that region.
"Now, after 10 years with our local family doctor, we need to find a new one," said Jason Chambers of Wellington. The adoptive father of four hit a snag last month while seeking treatment for his 11-year-old daughter's bronchitis. Her doctor treated her but said it would be the last time.
Chambers phoned the toll-free number on his CHIP card and was told his only option was to drive over the mountain to an in-network doctor in Spanish Fork. "That's 65 miles away — four hours round trip," to keep an appointment, said Chambers.
Health officials are working with SelectHealth to remedy the problem and have prepared a letter reminding Carbon and Emery families of their rights. Under federal law, CHIP patients must have access to a provider within 40 miles of their home.
If they don't, they can switch plans — the other option in Utah being Molina Healthcare — or petition SelectHealth to pay for an out-of-network provider, said a health department spokeswoman, Kolbi Young.
"There have been some transition bumps," she said. "But we're definitely aware of them. We're trying to make it as easy and seamless as possible."
This isn't the first problem with the CHIP revamp.
Earlier this year, 30 pediatric dentists protested the billing practices of the two for-profit dental insurers that inherited CHIP. Some threatened to stop accepting patients.
Legislation to privatize the CHIP program was backed by the insurance industry and sponsored in 2008 by Taylorsville Republican and insurance broker Rep. Jim Dunnigan.
The program was formerly run by the same quasi-public agency that handles health benefits for state employees, the Utah Public Employee Health Plan (PEHP).
But over the years, state worker benefits were scaled back while CHIP benefits remained the same, said Dunnigan. He said he sponsored his bill not as a favor to the insurance industry but to save taxpayer dollars and improve care through market forces.
PEHP was allotted a certain amount of state funding per covered child. If that amount exceeded claims, PEHP would give the state a refund at the end of the year. But more often, PEHP required a year-end injection of $1 million to $3.5 million, according to Dunnigan.
Now insurers take the risk and tell the state up front how much it will cost to cover kids. They absorb any shortfalls and pocket any surplus.
Whether the switch will be a money-saver remains to be seen.
"We have no data to show savings," said Young, noting better information will be available at the end of the fiscal year in June 2011.
SelectHealth, meanwhile, is working to expand its network, said company spokesman Spencer Sutherland.
The insurer contracts with Castleview Hospital in Price and 20 providers — mostly surgeons and therapists — in Carbon and Emery counties, but no primary care doctors.
It's slow going, though.
Chambers said his doctor applied to become a SelectHealth provider months ago and gave up after receiving no response.
"It's almost like a fight between the doctors and insurer, and the only ones getting hurt are patients who are sick and need care," said Chambers, who is equally frustrated by the lack of information available to families.
He doesn't recall ever being given a choice of networks, having been automatically switched to SelectHealth. And he believes that his complaints seem to go nowhere.
His daughter has asthma, and "with flu season coming, I hope this gets resolved before we have to have her medicines refilled," he said.
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