Dominic O’Brien rolled through a “press machine” as Maria Debertian guided the 8-year-old toward his mother during a summer physiotherapy session.
“You’re Dominic Hamburger!” Dubertian shouted.
Dobbertien is the owner of Occupational pediatric therapya practice of occupational, physical and speech therapy for children is now adjusting to some insurance changes that it expected would affect its patients in terms of waiting times and travel expenses.
Opened in 2014, it has increased 27 employees among three locations in Battle Creek, Caledonia and Solcraft and filled a void for specialty services in southwest Michigan.
“When Maria came into town, she was an ‘aha,’” said Heather Mason, O’Brien’s mother. “(Dominic) is like a complete baby care package. Anything and everything we can earn: eating, moving his tongue, fine movement, sitting and supporting himself for a few moments…we were traveling to Grand Rapids or Kalamazoo, and it was still substandard. And in Michigan winters, what do you do?
Since there are few pediatric outpatient clinics in the area, Dobbertein said the Battle Creek location attracts clients from all over Calhoun County and the surrounding area. But the recent change to insurance coverage through the Blue Cross Blue Shield that took effect October 1 affects how services are billed and delivered, creating problems for patients like O’Brien who need multiple services.
He can no longer do them “in a row” without his mother having to pay for secondary services out of pocket.
According to Blue Cross Blue Shield, the new policy will reduce reimbursement for practice expense portions of treatment procedures if these are secondary services or subsequent procedures provided on a single date of service by the same physician or qualified healthcare professional. Change was made to comply with Medicare and Medicaid Multiple Treatment Center PolicyBlue Cross Blue Shield officials said in their announcement.
Dobbertien said it’s working with more than 100 families with Medicaid-only primary health plans — about 60% of pediatric occupational therapy clients — and the change is expected to lead to longer waiting times for referrals and burden existing patients with more travel expenses.
“We have to be wary of our motivation mix just to stay open,” she said. “All I know is that I love kids and want to help kids… I’ve been seeing people for $5 an hour, with a master’s degree. I finally figured out some insurance, and now we have all those other kids. The insurance companies cut the reimbursement, but I give the same care” .
Occupational Pediatrics currently accepts six different insurances. Dobertian said that in light of rising insurance costs for co-pays, deductibles and premiums, some Medicare practices have adapted to membership models, where patients pay monthly fees. It’s a concept she’s considering for her own clinics.
“It will be increasingly difficult for clients to get the treatment they need,” she said. “Essentially, the longer a person is treated, the less you (the clinic) will pay. It will encourage providers to shorten your visits.”
Dobertian said she has reached out to nonprofit organizations seeking a grant to help offset increased travel costs for her patients, but has been unlucky because she runs a for-profit entity.
“Clinics like clinics make very difficult decisions,” she said. “When I started, a lot of people were like, ‘Don’t take Medicaid. You will never survive or be able to work. I was like, ‘I’m going to prove you wrong.’ And we did that for a while. But I have no control over this. It’s frustrating.”
Contact reporter Nick Buckley at email@example.com or 269-966-0652. Follow him on Twitter: @NickJBuckley