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S.E. Wood TennCare: Sounds too good to me! I'm going to be a little presumptuous here
and assume that most readers of this column are not among the
27 percent of the Tennessee population currently enrolled in
TennCare. I am going to further assume that most of
you don't really know much more than I do about TennCare, except
that it is a primary reason our state legislators say they need
to raise our taxes. So I went to the TennCare Internet home page,
www.state.tn.us/TennCare/index.html, and then to the listing
of TennCare benefits, www.state.tn.us/TennCare/benefits.htm,
just to get an idea of what makes TennCare so attractive and
so expensive. Didn't take long for me to find out. If you
want the complete details for yourself, go to the Internet sites
listed. For a quick reference, I have summarized the "medical
benefits" section only. The benefits for prescription drugs,
mental health, drug rehab, etc., etc., are listed elsewhere.
Benefit: As Medically Necessary Inpatient hospital days, outpatient hospital
services, physician inpatient services (including acupuncture),
physician outpatient services (including acupuncture), lab and
X-ray services, newborn services (including circumcisions), hospice
care, home health care, pharmacy, durable medical equipment,
medical supplies, emergency ambulance transportation, non-emergency
ambulance transportation, community health services, renal dialysis
services, rehabilitation services, private-duty nursing, speech
therapy, sitter and donor organ procurement. Benefit: Preventive, Diagnostic and Treatable
Services for Enrollees Under Age 21: Dental services and vision services. Benefit: As Necessary for Enrollees Lacking
Accessible Transportation for Covered Services Non-emergency transporation Benefit: When Determined Cost-Effective by
the MCO Chiropractic services. Benefit: Upon Recipient of Proof That a Covereed Person has Incurred Medically Necessary Expenses Related to Convalescent Care Convalescent care. Now don't get me wrong. There are those in
our community who are truly in need of medical services, and
we should provide a carefully managed health care program for
them. I am fortunate in being able to provide for my own BlueCross/BlueShield
medical coverage. It is good coverage. Expensive coverage. But
as generous as my policy is, nowhere have I been able to find
the phrase, "as medically necessary." Not once! There was a time when we would have called placing such open ended spending authority in the hands of those receiving financial benefit from such authority, "putting the fox in the henhouse." |