The Rural Wisconsin Health Cooperative (RWHC) has been a vocal advocate for the fair treatment of rural communities since our founding in 1979, when the five rural hospital founders of RWHC and myself led the charge to defeat a federally funded plan to close or consolidate most rural hospitals in southern Wisconsin.
RWHC is now owned and operated by 44 rural hospitals around Wisconsin with its offices and training center based in Sauk City. Our fight for fair treatment continues in all areas that impact rural health, especially with insurance companies and government payers/regulators.
We want to encourage all who care for rural Wisconsin to join us in working with health insurers to negotiate fair and value-oriented agreements with rural hospitals and clinics and to ensure that access to high quality care remains local.
It is a mystery to many of us why some insurers with record-breaking profits are choosing this time to come down so hard on rural healthcare. It has become common practice for some insurers to offer contracts with reimbursement terms that are less than what it costs the hospitals and clinics to provide the services, ultimately expecting the providers to lose money while they maintain double digit profits.
It is not uncommon for health insurers to use a “take it or leave it” approach in contract negotiations with rural providers and treat them differently by not considering, let alone making changes found in contracts for large, urban providers. In any event, RWHC has called out a set of health insurer behaviors which we believe rural communities need to see more widespread.
When a business or individual chooses a health insurer, we are asking that it becomes a priority to learn how the insurer will help or hurt their ability to get quality care locally and to keep their community strong and attractive. For the first time in many years, we have seen hospital closures in Wisconsin. We need to work hard to make sure we do not see more of them.
In addition to the premium, some important questions to ask a health insurer before being locked into a contract.
Do they include local providers in their network?
-Engage in good faith contracting with local providers?
-Recognize the actual cost of efficient and quality rural health care?
-Reveal “prior approval” delays for care; how many requests are denied and then overturned?
-Show how their profit margins compare with that of a local non-profit hospital?
-Support local providers in improving the health of the community?
-Acknowledge the critical economic impact of local care?
We encourage businesses and individuals to reach out to their local health care team before choosing a health insurance company.