Experience with public health insurance plans

Illinois and Fox Valley health care professionals give mixed reports on their experiences working with current public option health care systems Medicaid and Medicare.

"While it's true that sometimes the state is very, very slow in paying its Medicaid bills, it is not unlike dealing with a private insurance company," said Bob Tanner, the president and CEO of the Greater Elgin Family Care Center.

The center is a non-profit organization that provides health care to patients who are uninsured, privately insured or publicly insured. This year, Tanner said, his offices will see more than more than 21,000 patients from 194 zip codes.

"Our experience has been that (Medicare and Medicaid) are no more difficult than dealing with private firms such as Blue Cross or other commercial insurance payers," Tanner said.

But private insurance companies "also are very slow to pay bills, and they also have a number of rules and regulations they have to follow," he said. "They also deny claims. In our opinion, both insurance systems are at times challenging to work with, successfully bill and get the reimbursement back for the care we've provided to the patients."

Tanner assures, however, that everyone who comes for care at his facility receives the same "high-level quality care," regardless of what level of insurance they carry.

Margaret Kirkegaard, medical director for Illinois Health Connect, a primary-care case management program for Illinois Medicaid, does not agree completely.

"From my perspective, I practice one day a week in a residency program. There is a big difference between working in Medicaid versus private insurance," she said. "If you recommend a treatment to someone with private insurance, it is up to the patient to decide to receive treatment."

Patients with private insurance can weigh their options, Kirkegaard said. They can consider procedures and providers, and are able to make their decisions based on their financial situation and their medical need.

With public insurance, there is no flexibility to work outside the program, she said, adding that this can make health care more frustrating and harder to navigate.

"On the other hand," she added, "without that, the patient would have no access to care."