Provider fed up with reimbursement
CHARLESTON, W. Va. - Providers like Kelley Matusic, owner of My Family Medical in Hurricane, W. Va., are butting heads with the state's Medicaid program over its coverage criteria for phototherapy blankets.
Regardless of a physician's prescription, Medicaid reimburses only $45 per day for up to five days for the blankets, designed for infants with jaundice. While Matusic acknowledges that average use hovers between four and six days, it's not uncommon for infants to use the blankets for up to 10 days, she said.
Medicaid believes, however, that, if after five days an infant doesn't improve with phototherapy blankets, he or she may need to be hospitalized. Matusic doesn't necessarily buy it.
"You figure if a doctor's prescribing it--it's their call whether it's safe or not to continue treatment in the home," she said. "Our private payers don't have a problem paying."
Matusic said she has 13 blankets "that are out all the time."
"Even though I'm saving (Medicaid) money by providing a service that keeps infants out of hospitals, after five days, I have to eat (the loss)," she said. "But, you know, at the end of the day, I have a good heart, and it's more about the baby."