Decorahnews.com special report continues: Answering Annemarie Stockman's questions about health insurance

Postville resident Annemarie Stockman recently sent a well-written letter to the editor of the Decorah Newspapers about the local health care systems.  We're reposting that letter here, along with comments from decorahnews.com's Paul Scott about the questions she raises in the letter (Paul's comments will be italicized, to make sure you know which statements are his and which are Annemarie's).

"Dear Editor:  I just finished reading another article about the Winneshiek Medical Center.  A couple of weeks ago there was an article in the newspaper about the hospital falling short of their projected budget goal.  I was wondering why.  And it really got me thinking—no, it made me mad.

My husband had a procedure done and we had to go to the Waukon hospital because Winneshiek Medical Center will not accept our insurance.  I wanted to know the reason, because it did not make any sense to me that the hospital is falling short of their expected income and we had to go to Waukon for a procedure the hospital would have gotten paid for.

(Actually, Annemarie, there's a clarification needed here.  It is not that the hospital wouldn't accept your insurance—it would.  But all hospitals sign contracts with insurance companies, agreeing what they will receive in payments from the insurance companies for the work they do.  An insurance company that reaches an agreement is called an "in-network provider," while a company that hasn't agreed on terms is called "out of network."  Typically it costs you more to go to an "out of network provider."  In this case, your health insurance company hasn't reached an agreement with the hospital, so you would be forced to pay the hospital bill with more of your own money.  That's why people with your health insurance plan almost always decide to go to the Waukon or West Union hospitals, which do have agreements worked out)

I contacted one of our supervisors to find out if we, the Winneshiek County taxpayers, still own the hospital and found out that, yes, we do own the grounds, plus the hospital receives a small subsidy from us, the Winneshiek County taxpayers.

(Another clarification. The hospital will receive $435,600 from taxpayers during the 2012-2013 fiscal year.  I'll leave it to you to decide whether that's "small," "large," or "just right.")

I went to talk to a Winneshiek Medical Center Board member to find out why the hospital won't accept our Gundersen Lutheran Senior Preferred Supplement Insurance or any other insurance sold by Gundersen.  He assured me that they worked hard to get Gundersen to work with the hospital and Mayo, but Gundersen won't budget, won't work with them.

 

So I went and talked to my provider at Gundersen and was told no, this is not right.  Gundersen is more than willing to work with the hospital, but there seems to be an unwillingness on the hospital administration and Mayo's part to work together with Gundersen.

(Annemarie, welcome to health care in Winneshiek County.  Your experience is not uncommon among people who have talked with both hospital/Mayo officials and Gundersen officials.  The two sides point fingers at each other point, then, when asked whose fault the present situation is, they pass the buck—and you're the oner left having to pay!)

I know that Mayo is running the show at the hospital—fine, but the hospital is not a clinic—it is a hospital whose Board is elected by Winneshiek County voters.  It is the Board's responsibility to represent us, the Winneshiek County voters/taxpayers and not the Mayo or Gundersen health centers.  Let them fight their own battles.

(This was the approach taken by the hospital until 2005, when it signed a contract to buy Decorah Clinic from Mayo Health Systems and operate it as the hospital's clinic, paying a fee of over $7 million a year to Mayo for the doctor's salaries.  Hospital trustees now talk about "Our Clinic" when referring to the former Decorah Clinic.  Of course, Gundersen Clinic representatives hear this talk and begin to look at the hospital as a competitor.  That leads to more finger pointing by both sides—and you are still stuck in the middle, aren't you?)

The Board should see to it that all of us should be able to utilize the hospital.  How can one insurance plan be singled out and not accepted when all other plans are accepted?  This should come under the Board's responsibility to say all insurance plans should be accepted.  Is the WMC Board so taken in by Mayo that they are afraid to act in our behalf?  Boy, I hope so.

(Actually, the board is looking out for the hospital's financial interests.  The most profitable part of health care involves specialists, particularly specialists like orthopedists and anesthetists and other well-trained medical professionals.  If the hospital brought Gundersen "in network," it worries that patients would use the hospital—but then hire Gundersen specialists instead of Mayo specialists.  That would drain money from the hospital at a time when it's not performing quite as well as the financial goals it has set for itself.)

We, the people who have Gundersen insurance, have to take our monies to Allamakee, Howard or Fayette county hospitals while our Winneshiek Medical Center is falling short of the projected income goal.  The hospital administrator is responsible to Mayo, but the Board should be responsible to us, should advocate for us, as we, the people of Winneshiek County, elected them.

(All seven members of the WMC Board of Trustees are trying to do what they feel is best for the hospital and the county.  If you disagree with them, it is your responsibility to contact them and tell them your opinion—as you have done with this letter.  In a democracy, the ballot box is the final determiner.  You change policies when you change elected officials.  If elected officials get re-elected, they assume that the policies that they support must be popular with the voters.)