According to a recent segment on ABC News, yet another hospital in Tennessee is closing its doors. The main issue with this is that it’s the only one around for miles. It’s in a rural location, and the nearest hospital is around an hour’s drive away. If anyone has an emergency in that area, they may not make it to the emergency room until it’s too late. The people in charge at the hospital, Jamestown Regional Medical Center, stated that the Federal Government ceased paying their Medicaid and Medicare reimbursements back in May. Although this was the final nail in the coffin, so to speak, one can’t help but wonder what would have happened had the hospital been able to get all of their claims paid through the Federal ERISA Appeals system.
Hospital Closings Cause Issues in Rural Areas
Rural areas of the country depend on hospitals for many purposes. In some cases, they are the only places where people can go to see a doctor, thanks to satellite offices that house general practitioners and other specialists. The emergency rooms attached to these hospitals are fairly self-explanatory, although they do provide a crucial service to those in the area. On top of that, hospitals are sometimes the major employer in these quiet areas of the country, providing hundreds of employees with a paycheck. They employ nurses, technicians, orderlies, and others, all of whom depend on those jobs in an area where the main industry is farming.
In addition to those issues, there’s also the one that comes with a lack of an emergency room in the area. Where will people go in order to receive the care that they need, especially in the case of an emergency? As one resident of the area stated, “’ If something happened to our children — we live on a farm and farm machinery and snakes whatever. I’ve always just known that hospital’s there if we need it,’ Tracy Wright, a churchgoer, said of the Jamestown center.”
The Mayor of Jamestown expressed his thoughts on a similar issue, “’It’s just like accidents, or you know like tornadoes, something like that happens here,’ Lyndon Baines said. ‘We do get ’em here, and it could happen at any time, and then what are we gonna do?’” All that it takes is one natural disaster, and the lack of medical facilities will be evident.
Attempting to Keep the Doors Open
Despite all of the negative publicity surrounding the closure of Jamestown Regional Medical Center, there is still hope. The hospital recently appointed a new CEO, who hopes to open the facility’s doors once again after a staying closed for a while. He hopes that the temporary closure is enough to straighten things out and make the hospital function financially again.
However, this one example represents the major challenges that rural hospitals face. For example, “Rural hospitals face a variety of challenges. They tend to serve aging communities that suffer from poor health and require expensive treatments. There are often severe doctor shortages in rural areas, and gaps in insurance coverage if patients have insurance at all.” Thankfully, there is a solution to many of the financial woes faced by rural hospitals – Federal ERISA appeals.
Federal ERISA Appeals May Help
Every hospital, no matter where they are located, received three state-level appeals on every commercial health insurance claim that they submit. This means that the health insurance company can send that claim back a total of three times before they no longer have to pay it. At this point, many hospital administrators give up and fail to pursue that amount due to them. This leads to financial issues as those unpaid claims begin to add up.
The Federal ERISA law steps into play at this point, if the administrators send those unpaid claims to a specialist, forcing the commercial health insurance companies to pay up. As you can imagine, this can greatly help a hospital that has major financial issues, particularly if they are located in a rural area. Getting those claims paid can alleviate their debt and improve their finances. However, these claims must be done by someone who has the ability and know-how to do so.
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