Facilitator: George Barber and Melissa Sharits of TVA
NOTE: Questions and responses from all three focus groups were combined for the report.
NCF: “Yesterday, he’s got a rash of some sort. We tried to figure out what it was on him, so she had to find out. It’s been awhile. About a year or something. That’s only when he fell down the steps and broke his arm”.
TDH: “So you’re child’s been pretty healthy?”
NCF: “Yes, she takes real good care of him”.
CF: “Three weeks ago – fluid on ears”. Saturday – Ritalin. A week ago we had to get eye glasses for two children. Two weeks ago – two children had chicken pox. Two weeks ago for immunization. Three weeks ago with asthma and allergies.”
Facilitator: “What are the ages of your children?”
NCF: “My son’s almost five months old.”
NCF: “Mine’s seventeen. He’ll be eighteen next Wednesday.”
CM: “About three weeks ago he had bronchitis.”
CM: “About two months ago, my daughter has a spastic colon.”
CM: “About a week and a half or two weeks ago for my child who has asthma and a son who has cystic fibrosis. I take him here to his primary care physician and he has been referred to Vanderbilt for further testing. He’s five years old.”
CM: “About a month and a half ago to have two warts removed on his fingers that would really bother him. They would start bleeding. He has a really bad problem with warts popping up on him. I don’t normally worry about it, but they’re popping up everywhere. They freeze them, but they pop back up.”
CM: “Yesterday for further testing for an ulcer. He’s fifteen”
CM: “My son had to go about two months ago, because his leg is loosing balance.”
CM: “A week ago with bronchitis.”
CM: “Last week. His ear was bleeding. The first ear infection he’s ever had.”
CM: “My daughter went about two weeks ago for a physical. She has asthma.”
CM: “My little boy. He’s five. I had to take him about three weeks ago. He picked at our house dog, a Chihuahua, and he bit him in the lip and he had to have three stitches.”
NCF: “She’s on the TennCare program, because neither one of us were working at the time she got pregnant. She signed up for all of this, but she just recently went back to work and I recently got back to work myself and so we’re both in a situation were we’ll have insurance with our jobs soon. Until then he’ll be on TennCare.”
NCF: “I don’t know, because I don’t deal with mine. As far as I know she’s on this AFDC thing that’s all I know.”
CM: “TennCare.”
CM: “Myself and TennCare.”
CM: “TennCare depending on the medication.”
CM: “Mostly TennCare, but when I had to take my kid to the emergency room they told me they refused to see my daughter because my primary physician was someone they had never heard of and didn’t know what town he was from. I got the bill.”
CM: “My doctor makes sure she picks the medicines on the list that TennCare will pay for”.
CF: The attendees all said TennCare with the exception of one parent who paid out of his pocket, because he didn’t like to doctor provided.
NCF: “I really don’t know myself. She gets stuff all the time to look at.”
TDH: Do you get most of it from your wife?
NCF: “Yes.”
TDH: But you don’t know where she finds out about it?
NCF: “Like I said she just gets letters about different things about care and all of that, so I just pick up bits and pieces of what she tells me and says.”
NCF: “My wife as far as I know.”
CM: “I usually call the TennCare hotline.”
CM: “I usually call TennCare.”
CM: “TennCare or the directory TennCare provides.”
CM: “BlueCare book and TennCare book.”
CM: “I call the state if I need to change from one insurance to another.”
CM: “TennCare has been real good about sending the book and giving information on what is available. Eye, ear, nose, throat specialists, everything. That book pretty much explains everything that needs to be explained as far as who will take your child on the TennCare program.”
CF: Receive update on TennCare in the mail one a year. Also, from the Health Department and word of mouth. If there are any questions, they cal the hotline. Sometimes the parent gets the answer needed, but sometimes TennCare says they’ll return the call and then they don’t, so the parent has to call them again.
NCF: “From the health department is all I know”
NCF: “I have no idea.”
CM: “Family doctor I guess.”
CM: “I have kept my own records from day one. As far as the father, I don’t tell him anything, because he doesn’t care to know.”
CM: “My kids father know when I take them to the doctor for a ear infection or whatever.”
CM: “The Health Department and other information from the doctor. I don’t tell their father anything. He doesn’t ask. Unless it comes to him paying something, then he cares.”
CM: “From the doctor and the Health Department and school. His father doesn’t care.”
CM: “The doctor’s shot records and the father is not around.”
CM: “From the doctor and as for the father he’s never cared.”
CM: “I was raised in a very large family and we just knew those things.”
CM: “I have a shot card I keep up and I receive a pamphlet in the mail from TennCare. To make sure they have their immunization. If the father asks I’ll tell him.”
CF: Physician, school, personal records, check ups, and notices in the mail from TennCare.
NCF: “Maybe some different specialist.
Facilitator: “So, you’d like more information on the specialties available?”
NCF: “Yes”
NCF: “I would like to know that if there is something wrong with him she’s not the only one that knows it. I get to find out too, without her having to tell me.”
CM: “I can’t find any place to take care of my kids teeth on it. I’d like more information about dental care.”
CM: “I can’t think of any more information my child needs right now other than whether it will continue when she goes to college.”
CM: “I’m having trouble getting information on ADHD medications that are covered. I’d like more information on what ADHD is and what causes it. What are the chances that my younger children have it too?”
CM: “I’m getting everything I need now that I’m on HealthMed.”
CM: “More dental.”
CM: “Also, more information on ADHD. I’m always willing to take in more information on it. It’s an everyday situation.”
CM: “I can’t think of anything else.”
CF: Information about emergency services if the provider is not available and if your out of state. So far, everything has been covered and will call the hotline if there are any questions. Sometimes call the hotline and can’t get through and sometimes TennCare doesn’t call back in a timely manner. Would like a guide or brochure through the mail or provided by the doctor. The TennCare representative present had outreach materials which gave the MCOs 800 number that people could call to get information.
NCF: “I don’t have any control over it. He lives with her and I have to go buy what she says. Whatever she thinks is best for him. Stuff her insurance don’t pay for like dental or whatever, I would like to try to get that from an insurance that would pay for it so that he wouldn’t have to go without it. Like if he really needed it. Instead of trying to scrape the money out for something like that.”
NCF: “She just handles it all since he’s on her car. She’s picked a pretty good doctor, but he’s really not a basic pediatrician. If I could change that I would, but I just let her have a say so over it.”
Facilitator: “So you’d like to have a little more say so on your choice of physicians?”
NCF: “Yes, we’d rather go to a straight pediatrician rather than a family practice doctor, but he’s done a pretty good job so far. That would be the only thing I’d really change would be to go to a pediatrician.”
TDH: “Are there many pediatrician that practice in the Springfield area?”
NCF: “There are two or three around here, but she just knows this particular doctor and when they ask her she just said his name, so that’s who his doctor has been.”
CM: “I would like him to pay for my child’s insurance, but he chooses not to. That’s the reason we have TennCare, because his father won’t. I would make him carry it.”
CM: “Pretty much the same. I would like him to ask me how the children are doing or call. I would let him know. I would have no problems letting him know about his children’s health. I would hope that he will be more of a role model in their life. At a young age they need to know that even though mom and dad are divorced and mom reaches that pick of frustration they can call dad and dad’s available. When they’re not available mom takes over the whole responsibility role and it’s a shame.”
CM: “Be involved. Spend some time with them.”
CM: “If I ask him to help pay I wish he would. He doesn’t neglect them he just throws a fit about it every time.”
CM: “My kids dad knows everything like if one goes to the doctor or one goes to the dentist. Their dad knows. He doesn’t take them. I’m always the one who takes them.”
CM: “Right now I don’t think I’d want to change anything about it. I let him know if something’s wrong, but yet I’m the one who makes the decision. If the baby’s got to go to the doctor for a check up or something I don’t want him to step in and say I’m going to take him. I take care of this baby everyday. I’m going to take him to the doctor and be the one there explaining to the doctor what’s been going on and care what the doctor has to say about it. I do my part. I let him know regardless of what it is, but I don’t want to change that.”
CM: “I think he should be in jail, because he quit his job to keep from paying child support. I think if they don’t take care of their kids they should be put in jail. He doesn’t care what happens to her.”
CF: “I get it because I’m disabled, but I’ve got two step kids and I don’t know who their daddy is. I’ve had them since they were about two or three years old. Both me and my wife make decisions.”
CF: The mother handles everything unless it’s a major emergency.
CF: Both parents are involved in the decision making.
CF: Father handles everything unless it’s a major emergency then the mother is informed.
CF: Both parents don’t always go to the doctor together with their child, but they discuss at a later time.
NCF: “Get her to listen to some of the things I say. When I tell there’s something wrong if he’s sick. That’s the only reason I would have very much to say about is if he was sick”
NCF: “I can’t say anything except what I said awhile ago about the different insurance’s and everything because she does everything she’s supposed to and if he’s sick or this or that she takes care of him.”
CF: “If I have more knowledge of what is covered. Having more than just one particular doctor that you can take him to in an emergency. That has to come out of my pocket.”
HCFA to TCR: “What happens when the child can’t get an appointment with their doctor and it’s an emergency, but not life or death. Can they go to another provider?”
TCR: “They’re supposed to go to their primary care physician. If they can’t see them right away try to see someone else or go to the emergency room. “
CF: “I’d like to have more information on the insurance companies on what all the carriers are and what they carry. Once a year you’re sent a notice on switching to different insurance companies and how can you pick if you don’t know what they’re doing?”
TCR: “I’ve got a list of phone numbers you can call with questions like that.”
CF: If I could understand health care better. Know what the service covers and doesn’t cover. Would like to be aware of coverage such as what you can and can’t use TennCare for. Would like to have received information about TennCare when I moved to Tennessee, but had to find out through the Department of Health and my physician. More information on all insurance and what it covers. Question about what happens when their is an emergency and you don’t have time to telephone the MCO. What exactly is the definition of an emergency? The TennCare representative said that all emergencies were covered by TennCare no matter where you are, even out of state. The MCOs decide what constitutes an emergency but you can appeal their decision if you feel it is not correct. Outreach materials were on hand and available to the attendees.
Facilitator: “What is holding you back from being able to make these decisions? Is it something in the system, the courts, between you and your spouse, the child’s mother or what?”
NCF: “No, she does everything she supposed to do so I there’s nothing that I can say about it because she does everything right, so I can’t complain”. If he gets sick she’ll call me”.
NCF: “She picked a doctor. I’ve watched him examine and everything, so he does a good job and everything, but like I said I would just pick a straight pediatrician.”
CM: “The pediatrician I used to have, if I went for a second opinion I would have to have a referral from the first doctor and she wouldn’t give me a referral, so I went anyway and she got mad. I don’t think I should have a referral to get a second opinion.”
CM: “If you’re on TennCare your supposed to do what they say. If you need to go to a specialist and they don’t like them they won’t let you see them, because you have to have that referral to go to one. Or I have to pay for it myself and if I could pay for it myself I wouldn’t have TennCare.”
CM: “I would like to have options to go to another doctor or specialist.”
CM: “If I felt more responsibility with my pediatrician and if they showed more interest. The doctors on the card. Not just seeing their names on the TennCare list and saying well I’ll give you this. I want more interest shown to my child whether he has Blue Cross Blue Shield, or he has TennCare. He is still a child and still needs that undivided attention.”
CM: “I feel that if I had a good job and if I could afford it. I’d pay it for myself.”
CM: “If I could choose my own doctor, because some of the doctors have a bad attitude. Sometimes they walk in, right a prescription, and walk out. They don’t give a thermometer or anything.”
CM: “A better job to pay for it myself.”
TDH: “I was just wondering if anyone had tried to change to another physician because they had encountered an attitude?”
CM: “We only have three doctors here. That’s all.”
CM: “I feel like if I’m in Nashville for some reason and I have my children with me if something happens to them I should be able to take them to a doctor there, to a walk-in clinic and have my child seen. Not be told, “I’m sorry we can see this child, but you have pay for the insurance.”
TCR: “I don’t want to offend anybody, but I think it depends on what’s defined as an emergency. If the child’s ear starts bleeding I would call that an emergency and I would take my kid straight to the hospital too. Whoever you were dealing with should have realized. They should have briefly looked at the child to see if it is something that needs to be treated right now or is it something that can wait until you can get to the child’s doctor. It sounds like you were misinformed. One of the things we hope to accomplish with TennCare is to take away some of that bias when you have that card. We want you to walk in and you show them your TennCare card and them not know whether you came through Medicaid or whether you enrolled through the application process“.
CF: There aren’t many providers in the area and sometimes we are not able to get into the doctor who is the provider in an emergency.
CF: Haven’t incurred any problems.
CF: Ability to get them in to see the provider at the time of need.
CF: When transferring insurance I was put on a six month to one year waiting list, so I had to pay out of pocket until the wait was up.
CF: Some attendees reported no problems in accessing physicians. Others reported long waits at the physician’s office during the work day. One attendee reported a long wait for a pre-existing condition. The TennCare representative said that there was no wait for pre-existing conditions. It turned out the attendee was talking about other health insurance carriers.
CM: “Dental until they’re a certain age.”
CM: “Eye exams, physicals.”
CM: “They pretty much take care of the kids under eighteen then you’re on your own”.
CM: “Just about everything you want to know is in the book. It’s pretty self explanatory.”
CF: “I guess they cover it real well in a sense. I know my children are covered through the TennCare. Like my oldest girl. They had a mix up somewhere and were supposed to have her on there and then for some reason it don’t show they’re paying the bills, but everything else seems to go pretty well.”
CF: “My wife knows more than me. She does try to fill me in on it and I’m not totally in the lost, but she deals with it more than I do, because I’m gone a lot.”
CF: “Most of the time we find out by the case worker we have.”
CF: “I’d like to know more. I don’t know everything other than what the doctor tells me. He lets me know.”
CF: “Know everything, but if something comes up I would like the doctor to let me know.”
CF: The mother knows what is provided, the case worker fills us in on the services provided. Would like to know more about services other than what the physician tells me.
CF: I only know what the doctor tells me.
CF: The physician tells me what is and isn’t covered.
CF: Knows his children are covered.
CF: Most expressed the knowledge that if a question comes up they can call the provider of MCO and get an answer. DHS case worker fills in one parent on all details. Mother deals with it. The TennCare representative asked if anyone got a handbook from their MCO explaining the services provided. Most attendees said that they had. A list of all MCO telephone numbers was provided.
NCF: “High School and television.”
NCF: “How did I learn about it? Because I’m on it.”
Facilitator: “Before you got on it did you hear anything about TennCare?”
NCF: “I heard it on television.”
CM: “Welfare office.”
CM: “Health Department.”
CM: “Television.”
CM: “Newspaper”.
CM: “Some of the clinics.”
CM: “Believe it of not, the library.”
CM: “Word of mouth is pretty good. Especially in this county.”
CF: “After I had my accident I lost my job and went to DHS. The doctors office sent me to DHS because I told them I couldn’t afford all those medical bills.”
CF: “The Department of Human Services when I went through a lay-off.”
CF: “The Health Department.”
CF: “When I moved to Tennessee I went to DHS to apply for it.”
CF: “The Health Department got us started and told us if we need some more assistance to come over there and fill out paperwork.”
CF: Physician referred him to the Department of Health who referred him to Medicaid/TennCare.
CF: The Department of Health informed him when he went through a layoff.
CF: The Department of Health during immunizations.
CF: One attendee moved to Tennessee and was referred to DHS and subsequently signed up for the program. Some got their information through word of mouth at their church.
NCF: “Anything that is available, just more general information on the program. I’d like to find out about all I can.”
NCF: “As far as that goes, anything that does change they send me letter, they send me booklets.”
CM: “Probably a list of the type of drugs that they pay for.”
CM: “If there’s a possibility of an older child having TennCare to pay for glasses and dental.”
CM: “Just additional information on what new things are coming out that TennCare might cover.”
CM: “I started working on my GED and if it wasn’t for my doctor volunteering to give so many people eye exams. I can say I probably wouldn’t have passed my GED. In order to better yourself to get that job so that maybe you can take care of yourself so you don’t have to go to TennCare and Social Services. You got to be able to take care of yourself before you can take care of your children.”
CM: “More information on drugs TennCare will pay for.”
CM: “More information on why they won’t pay for certain drugs. When your trying hard and doing what your case worker says you’re supposed. Why they won’t pay for certain things.”
CM: “Just more information on why they won’t pay for certain drugs that your child might need for one reason or another. Even if it’s not a regular basis, but if they get hurt or something. My daughter had pneumonia, and the cough medicine my doctor prescribed, TennCare would not pay for it I had to pay for that myself.”
CF: TennCare representative answered these questions individually.
NCF: “Possibly through the child’s doctor who could get in touch with the other parent or whatever and let the parent know. It’s kind of hard when parents don’t get along it makes it difficult.”
HCFA: “Both you guys said that you do go to the doctor with your wives on occasion. When the doctor tells you what the condition of the child is do you feel the doctor is speaking to you just like he speaks to your wives or do you think he’s more tuned to telling your wife what’s going on, you just happen to be there? Do you get a feel that he treats you as an equal to your wife?”
NCF: “I feel he tells you more when both of you are there instead of saying well I know they’re not together and I wished he wasn’t here so I could tell you this, but they when both of you are together they tell you everything. I think it’s better for both of them to be there anyway.”
HCFA: “How do you like to receive information? Is it best to get it in the mail or see it on television or hear it on the radio?”
NCF: “I would rather read it myself. When it comes directly to me then I have more access to it rather than if I catch a glance of something on television I may not catch it all. The same on the radio. Reading to me is my best way.”
HCFA to TCR: “With the switch over to TennCare, TennCare has obviously done a lot of outreach. What kind of outreach have you gotten besides television ads, letters, etc.? Do you ever take surveys?”
TCR: “We’ve done a lot of outreach recently. Basically we just opened enrollment for children again. We close enrollment after the first year except for the uninsurable and Medicaid. April 1st we open enrollment to children. Since we made that announcement in January we done 35, 000 outreach letters to people who were on food stamps and receiving various forms of aid. The local health departments have held town meetings inviting people to come in and hear about TennCare and we’ve targeted those towns were there were factories closing down. Those kinds of things. The University of Tennessee has done a recent satisfaction survey of the people who are on TennCare and I can’t remember all the numbers, but I think it’s in the neighborhood of 75 - 80% of the people are reasonably satisfied with TennCare.”
Facilitators: “Is their any certain way that MCOs pick providers to sign up?”
TCR: “It is up to the providers to participate with one or all of the MCOs. The attendees said that they didn’t want to have to change physicians but realized that it was necessary at times. Everyone present said that they had been required to change physicians at some time for some reason.”
HCFA: “Before your son was receiving TennCare he was on Medicaid. Do you seen any difference in the Service?”
NCF: “I can’t tell. I don’t know, because I’m not with him”
HCFA: “Did you ever hear your wife complain when he was on Medicaid?”
NCF: “No”
TDH: “When TennCare started did you change physicians or were you able to keep the same physician?”
NCF: “I think she may have had to change physicians.”
NCF: “Is there a certain process they go through to pick the doctors? Do the doctors just say we accept this or we don’t accept this?”
TCR: “It’s basically up to the physician to decide whether he wants to participate. They can’t participate in one or all of the programs”
HCFA: “Are you concerned about the quality of the doctor?”
NCF: “No, just the way you have to change doctors.”
CM: “I would say that anyone who says they have children whether they’re there or not should get information.”
CM: “I already answered.”
CM: “Through the mail.”
CM: “Every few month, send information to the father about the child’s issues and health care in general.”
CM: “He don’t need the information if he don’t ask for it.”
CF: “The phone. She’s clear out in Utah.”
CF: “Through the doctors where you take your children or word of mouth. Maybe by the parent.”
CF: “The phone, answering machine, or whatever.”
CF: “I don’t contact my ex.”
CF: “Television, radio, 800 number.”
CF: Phone the mother, phone parents, word of mouth, physician. Don’t contact mother. Advertise a hotline on television for non-custodial parents to call in for information.
CM: “Right now I’d like enough money to pay for my own insurance.”
CM: “The amount of physicians available in the area.”
CM: “The physicians to show a little more interest in this county. Just more compassion for the children.”
CM: “More care for the children and more availability.”
CM: “As far as my primary pediatrician goes I can call him in the morning and say I’ve got a sick child and I don’t have any problems taking him in. The only thing is, I have to drive all the way to another city to see him. It’s along drive to get him there.”
CF: “Like if she’s having an asthma attack or allergy attack and I know she needs to go to the get a shot, but I can’t get in to my regular doctor or he’s not in that day then I have to go to another and they say your card doesn’t cover this one, it gets aggravating.”
CF: “I don’t really have any problems. When I need to get in to see my physician I either call his office or if I have to I’ll call him at home. He’ll even make house calls for me he’s really good. The way I met him is our kids are both in day care. There have been a few times I was at the day care and ask a few questions and he’d tell me to see him tomorrow and I’ll have a prescription for this or that. We go fishing together and stuff.”
CF: “Sometimes I have to wait awhile at the doctors office, but they usually see him that day or the next day.”
CF: “I think sometimes finances, if you don’t have insurance or you’re coming in between transferring from one insurance to another and then on certain cases you have to have a waiting list for a person, because of some type of allergy or what ever condition you’re in. You may not have enough finances and I can’t wait six months to a year. I need to go to the doctor now and so you’re in a bind right there. What about a parent who is trying to get another insurance or trying to get on TennCare with heart condition or sugar, something like that. I’ve heard of that case where they won’t pick you up until you wait a whole year.”
CM: “How does TennCare determine co-pay and deductible?”
Facilitator: “I think what I’m going to do is go ahead break up the meeting and let our TennCare representative handle the TennCare questions.”
TCR: “The co-pay and deductible only applies to those that enroll by application, not ones who come through DHS and Social Security and what it’s based on is family sized and income. You would have filled out an application and mailed it in yourself, or you would have gotten it through DHS. Do you have a co-pay and deductible?”
CM: “No.”
TCR: “Then that means either your on through Medicaid or your income family size has exempted you from that.”
CM: “What can we do in this County to get more pediatricians, specialized care and equipment? They haven’t delivered a baby in twenty years.”
TCR: “I’ve been with Medicaid since 1984. I was in this from the beginning. I worked the hotline since 1984 for 18 months and the biggest thing we’ve heard, the biggest problems we’ve heard quite honestly is the physicians and their problem is that they’re used to being in charge and now they’re saying we’re trying to tell them how to practice medicine. We’re not trying to tell them how to practice medicine. We’re trying to make it available to everybody as we can. Now I don’t know how many GP’s or Pediatricians are in this area. If the area is un-served I know we have a program where we try to work to get doctors to relocated in areas that are under served. They offer them bonuses and have them set up their practices and a number of things, but there is no way we can force them to do it.”
CM: “One thing I’m concerned with is the doctors that fall under the TennCare plan do have a right to say we don’t want TennCare. I’m I right? I mean they have to voluntarily agree.”
TCR: “They voluntarily agree to take TennCare.”
CM: “Why do they show absolutely no interest when you show see that card. They complain about it.”
TCR: “That goes back to what the exercise the facilitator did which was about attitude. That’s a problem that we have primarily with physicians and their attitudes. As I said a few minutes ago part of the purpose of the program was to not stigmatize anybody so that they don’t know if you got on through DHS or whether you submitted a application and pay a premium and so forth. That you should get equal treatment as anybody else that comes through the office. Obviously we haven’t succeeded with everybody and the things you can do about that as far as your individual doctor is to let your MCO know the attitude that you’re experiencing with your physician and if enough people complain then they can go to the doctor and say “we’re getting these complaints, we need your help or we need to pull your contract and send them to somebody else”.
CM: “I have a daughter who is getting ready to go to college. Will she still receive TennCare?”
TCR: “As long as she remains a part of your case there is no problem. I believe in the instances of both DHS and Social Security that if a person’s TennCare that we send them an application by mail saying that if you’ll fill this out and return it within 30 days your TennCare will continue. As long as she remains a part of your case there’s no problem. Some colleges have insurance you can get that’s usually pretty reasonable in terms of cost, but that would be available.”
CM: “My daughter had shoulder surgery, I have disability, and it cut her off during her therapy and then it came back later, but I had to pay for that therapy in between times. Shouldn’t that have carried all of that the same?”
TCR: “That’s something I can’t answer for you. That’s an eligibility question.”
CF: Better eye glass coverage, dentist coverage. (Dentist didn’t want to give root canal because he felt is was a waste of money to handle through TennCare).
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