Sep 16, 2009 11:48 pm US/Eastern
Health Care Dispute Leaves Family In Limbo
DOWNINGTOWN, Pa. (CBS 3) ―
For the young mother of a child with mental illness, an ongoing dispute between a local hospital and an insurance provider is presenting a new set of challenges.
Tiffany Formica, 7, has had cerebral palsy since birth and also suffers from a degenerative brain disease. Suffering from seizures and other medical problems, Tiffany's mother April has become accustomed to constant trips to the hospital and doctor's office.
"Pretty much her brain hasn't formed or hasn't developed past the age of 3-months old," says April. "She depends fully and completely on us; she's non-vocal and does not eat like a normal person."
Chester County hospital, a mere 20 minutes from the Formica home, is where many of the doctors who have treated Tiffani since birth are associated. And, like an estimated 19,000 people in Chester County, Tiffany's Medicaid insurance is provided through Keystone Mercy Health plan at the hospital.
"Without Keystone Mercy, we would be so far in debt it wouldn't be funny," said Formica.
At the end of September, the contract between Keystone Mercy and Chester County hospital is set to expire and the two sides can not settle differences on reimbursement rates that effects thousands of people.
"Of all of the deliveries that were provided in Chester County to Keystone Mercy patients, our hospital accounted for 70 percent of the total," said Ken Flickenger, CFO for Chester County Hospital.
Therefore, if Tiffany's mom stays with the health insurance provider, Tiffany would no longer be covered at the hospital where she was born.
Concerning their customers, Keystone Mercy's president Anne Morrisey says "we are working to help them move to one of the other more than 2,000 physicians, 8,000 specialists and nearly 60 hospitals in our network."
For families like the Formica's, this proposition creates a new set of challenges.
"The drive to a hospital that deals with children and takes her insurance is an hour and 15 minutes to an hour and a half away," April says.
While Chester County Hospital works to iron out a new deal with a different health insurance provider, April and Tiffany will have to wade through this changing tide in health care.
(© MMIX, CBS Broadcasting Inc. All Rights Reserved.)
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