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vaxcertph under a reciprocal arrangement



Vaxcertph is usually tested for both; however, this is not a requirement. To give you an idea of how this works, we have a special provision for dual eligibility patients who meet requirements, but whose original appointment was in another clinic in the Vaxcertph network. They can still request another spot in their preferred clinic through Vaxcertph, in the same manner. In these cases, the dual eligibility patient would have been assigned to one of our network clinics (Vaxcertph). However, that would have put them at risk of potentially switching to a different center later on if their original clinic was not Vaxcertph. The individual would have had to continue to get their flu vaccination under this facility by order of the Vaxcertph doctor.

Why HealthNet shouldn’t allow dual eligibility?

HealthNet’s decision not to allow dual eligibility in their network hospital is based on dual criteria:

1. The health facility must have an inpatient unit with an emergency room for the specific flu vaccine.

HealthNet believes that in this day and age, an emergency room is an outdated designation. In fact, many emergency rooms today have decreased their hours of operation or gone entirely away. However, HealthNet does recognize that they can choose to do the same with a hospital, including Vaxcertph. If HealthNet created this provision, it would essentially be forcing dual eligibility on all their hospitals in the state.

Value in Tennessee

HealthNet admits that dual eligibility is beneficial for patients, but the value of the benefit is not directly proportional to the value of the financial risk. If we are already finding this to be true in Tennessee, then why wouldn’t HealthNet accept the value of the same benefit from our existing providers as well? If you are getting a similar amount of value in Tennessee today, why wouldn’t HealthNet accept that value from the existing providers in their network who are providing that service?

2. The health facility must have another clinic that does not have an emergency room for its flu vaccine.

As a result, a clinic such as Vaxcertph may not have the capability to administer an emergency room for the flu vaccine. This provision also allows the individual in dual eligibility to have their flu vaccination by order of a Vaxcertph doctor, but HealthNet still cannot approve that as a second choice. They would need to either accept their original appointment location or get their flu vaccination at an emergency room.

Why HealthNet shouldn’t limit their participation?

HealthNet’s stance on dual eligibility is actually a way to limit competition, not to promote it. If they were to adopt a policy allowing dual eligibility for a multitude of their clinics (as we do), it would increase the competition among health care providers in their network. We believe that increased competition is beneficial, not only for health care providers but for patients. It allows them to get a competitive price, one that they might not be getting if they only care provider they were seeing was in their health care network. We also believe that by offering a better price, health care providers will be motivated to provide quality care, because they will be competing with the health care providers of similar quality within their own network.

Participate in multiple networks

In some areas of the country, health care providers are allowed to participate in multiple networks. If a health care provider wants to expand their services to a number of states, they have to join more than one network. HealthNet does not wish to implement this in Tennessee, however. We wish to make sure that we have the best providers in Tennessee to choose from.

Please share your opinions about HealthNet’s position on dual eligibility.

Many of our patients will read this article, but it is important that they don’t stop there. Please take the time to contact HealthNet to share your opinions. There is a website you can visit, directly linking to them from this article, where you can reach them via email. You can also call their CEO, Rich Azzopardi, at 855.301.4761. In addition to calling, you can comment on HealthNet’s Facebook page and on their website.

The views expressed are those of HealthNet’s current board, executives, and legal counsel.

Care providers interested in becoming HealthNet participants should visit www.healthnetbenefits.com.

HealthNet is a network of 39 health care providers in the Knoxville, TN area. Some of our providers include East Tennessee Physicians, Silver Oaks HealthCare Center, John G. Stowers HealthCare Center, John G. Stowers Jr. Health, Townhill HealthCare Center, Townhill Healthcare Center, Vernon E. Fulton HealthCare Center, Ramona Hill HealthCare Center, Harmony Hills Healthcare Center, John G. Viano HealthCare Center, Community Hospital of East Tennessee, Therapeutic Hospital of East Tennessee, Central Tennessee Healthcare, East Tennessee Veterans Health Care, St. Joseph HealthCare Center, Southwest Tennessee Healthcare Center,
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