The Access to Health Care Network (AHN) has signed contracts with more than 500 doctors at both Renown and Saint Mary’s regional medical centers to provide lower cost care to the uninsured and the working poor. The nonprofit business exists in a climate where nearly one-third of Washoe County residents are uninsured or underinsured, according to an annual study by the University of Nevada School of Medicine.
These people will face an average emergency room bill of more than $1,000, according to a 2007 study by the U.S. Department of Health and Human Services. However, many know that the cost of health care may be much higher.
Lack of insurance isn’t the only requirement to acquire or maintain AHN membership. Clients must pay a membership fee to AHN, which can range from $40 per month for an individual to $90 per month for a family. Applicants must be approved in an initial visit and then meet with one of the network’s 16 consultants on a regular basis thereafter. Members must have an income between 100 and 250 percent of the federal poverty level and must not qualify for Medicaid, Medicare or the state’s answer to low-income coverage, Nevada Check-Up. Also, according to AHN executive director Sherri Rice, the client is cut from the program after two no-shows to appointments and any non-payment.
Currently, the program helps more than 4,500 people. In the past two years of its existence, 25 people have been asked to leave, Rice said.
For their discounted medical services, AHN clients must pay up front and in cash. Once admitted to the emergency room, AHN patients are expected to pay a $600 per diem rate with a $3,000 cap on expenses. Urgent care visits cost $70 for clients of the network and a check-up trip to an established doctor would cost a little more than $40.
“It is a shared responsibility model and that’s what makes it work,” said Chris Bosse, Renown Health’s vice president of government relations. “By participating in the program, Renown Health is assisting patients to access care earlier and more frequently translating to a cost savings in emergency room visits.”
More than 990 physicians provide medical care through Renown, according to Renown spokesman Dan Davis.
“The physicians give up something as well,” Bosse pointed out.
“The physicians, it is their give-back to the community,” Rice said. “It is the providers that make this work.”
Essentially, the physicians are giving the discounted care as an act of community charity.
One area hospital that currently has no physicians participating is Northern Nevada Medical Center. According to NNMC spokeswoman Kim Stoll, the center takes a more individual approach.
“We do look at those things on an individual basis,” Stoll said, explaining the doctor-patient relationship. “We do what they do with negotiating, but on an individual basis.”
According to a letter distributed by the AHN and endorsed by the Washoe County Medical Society, physicians are asked to join the program for one of several reasons.
“It is a way to be paid for your services from a population that often does not pay when seen through ERs,” the letter stated. “We also believe that AHN will help curtail any unnecessary emergency room visits. You are paid cash at the time of service. This spares your office staff the time involved with billing, utilization review or prior authorizations. It is a way to contribute to the community without having to give your services for free. This is a population from which the threat of liability issues is very low. Members are required to sign a waiver agreeing to mandatory arbitration should a dispute ever arise. … If the entire medical community comes together to help with this program, we can spread the patient load so no physician is over burdened.”
The multi-faceted group also offers health care plans to employers who share the cost of the annual fee with their covered employees. But Rice emphasizes that the AHN is not an insurance plan and that eventually, some members will transition into traditional insurance products.
Neither Bosse nor Rice believe that the network is the end-all answer to a national health care system in need of reform.
“I don’t think we are the answer, but we are one of them,” Rice said. “Our providers could not afford to have their entire (cost) be Access (cost).”