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Missoula firm helps cut costs for those with no coverage

People who don't have health insurance get a double whammy: First, they pay 100 percent of their health costs out of their own pockets. Second, they pay full price, with none of the discounts negotiated by insurance companies.

"From a public policy point of view, in Montana, those who are the least able to pay are those who are forced to pay the most," said Mark Hawkins, president and chief executive officer of InterWest Health, a Missoula-based company that puts together provider networks for the use of insurance companies and other payors for health care.

Hawkins' company has a new idea that it hopes will make a dent in the bills of the uninsured. PPO Direct works like a consumers' buying club: Its members pay an annual fee - $120 per person or $180 per family - and get in return discounts of 20 percent and more at providers in a statewide network of about 1,500 physicians, hospitals, surgery centers, pharmacies, eye care centers, chiropractors, nurse midwives, nurse practitioners and others. About 400 of the providers are in Missoula. The member must pay by cash or credit card at the time of the visit.

InterWest put PPO Direct on the market last week, and inquiries kept their phones busy, said Hawkins and marketing director Kristin English. Its Web site logged 4,000 visits from Sunday to Friday, they said.

"We've been very delighted with the response this week," Hawkins said.

The program, the first of its kind in Montana, appeals to providers because it cuts down on paperwork, and it might enable patients to come for care who could not have afforded it without the discount.

"We've received a lot of calls from providers," Hawkins said. "Many of them are concerned with the uninsured. They see them every day."

While useful to people with no insurance, PPO Direct could also help people with insurance plans with large deductibles or people who want to use alternative care that their plans don't cover - for instance, chiropractic care or acupuncture, Hawkins said. The discount cannot be applied to an unpaid portion of a bill covered by insurance.

As well, seniors who have Medicare only and no private insurance for prescriptions could also benefit, he said.

"That's a huge expense for the elderly," Hawkins said. "Many senior citizens in Montana don't have any coverage at all for prescription drugs."

About 20 percent of Montanans have no health insurance. Only four of every 10 employers offer health insurance to employees. At a March forum in Missoula, national and local specialists said that uninsured patients cause health insurance premiums for the insured to be 30 percent higher than they need to be. Hospital emergency rooms are busier with people who are sicker and less able to pay. And hospitals are forced to raise prices because of the millions of dollars of care they are forced to give away.

Medicaid and public health clinics, as well as such programs as the government-sponsored Children's Health Insurance Plan and Blue Cross and Blue Shield of Montana's Caring Foundation, are able to help people with no resources. But the vast majority of middle-income people in Montana see no relief.

"Everybody's talking about 'the uninsured, the uninsured,' but nobody ever does anything about it," said Missoula neurosurgeon Nick Chandler, board chairman and founder of InterWest Health and the brains behind PPO Direct. "This is not the ultimate great solution. But it's a start."

Chandler is involved with a Georgia-based company that tried such a program; he decided it was a good idea for Montana.

Chuck Butler, vice president for government and public relations for Blue Cross and Blue Shield of Montana, said every effort helps.

"Anyone who's making an effort to try to help people who are uninsured and of limited incomes to help them pay for their medical care is a good thing," he said. 'The ideal, of course, is we all should be working together to find solutions to getting affordable health insurance."

"For people with insurance," Butler said, "I'd question the value of the $120. For someone who's uninsured, there's some value there."

Butler said Blue Cross is working on a program that will put together a network to offer uninsured Montanans coverage at substantially reduced premiums.

"Several hospitals and several physicians have agreed already," he said. "We're going to be talking to everybody."

Hawkins stressed PPO Direct is not insurance and not a replacement for it.

"People are not going to drop their health insurance for this," he said. "And we aren't encouraging that. … We very much tried to create this as a win-win situation between the patient and the provider."

More information

For more information about PPO Direct, call InterWest Health at 542-1912 or toll-free at 1-877-542-1912, or look at its Web site at www.ppodirect.net.

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