Interstate 94 stretches like a lifeline between Mary L. Anderson's home in Moorhead and her cancer treatment team in Minneapolis.
She makes the four-hour trip every other month, so doctors can adjust the prosthetics on her face, where the cancer ate into the bone, and make sure the aggressive disease hasn't returned. But she doesn't make the journey on her own.
Anderson is one of thousands of Minnesota Medicaid patients who rely on nonemergency medical transportation companies to get to their doctors, chemotherapy and dialysis appointments, or the hospital.
Now, a rift between the state's largest health insurer and outstate medical transportation companies has left patients like Anderson worried about their next ride.
"I don't know what to do," Anderson said, near tears over the news that Blue Cross and Blue Shield of Minnesota had terminated its contract with the medical van service she'd been using since her diagnosis in 2004. "Blue Cross told me I'd have to find another driver. I don't want to die because of this."
In late November, Blue Cross announced that it was cutting ties with its rural transport contractors. Instead, it hired Medical Transportation Management — a company that already coordinated nonemergency medical transportation in and around the Twin Cities but has a fraught history at the Legislature — to oversee travel arrangements for some 100,000 Medicaid patients in outstate Minnesota.
As of Jan. 1, if a rural medical transportation company wants to do business with Blue Cross, it has to contract through MTM.
Companies fight back
The transportation companies fought back, filing a complaint with Minnesota Attorney General Lori Swanson. They cited not only the 30 percent rate cut they were being asked to accept, but also MTM's history with regulators, including a $2.5 million settlement it paid the state of Missouri a decade ago for antitrust and Medicaid fraud.
With many local providers refusing to contract with MTM, the companies say patients have been having a rough ride in the first days of the new year.
"You have people missing dialysis appointments all over the state," said Mike Pinske, president of the R-80 Non-Emergency Medical Transportation Coalition, which represents companies in 80 rural Minnesota counties. Before Blue Cross ended their contracts, coalition members provided an average of 700 rides a day to its Medicaid clients.
"I'm heartbroken as to what's going on here," he said.
In Mankato on Thursday, Tom Roberts started making calls at 7 a.m., trying to find someone to drive his 93-year-old mother from the hospital to the New Ulm nursing home where she would recover from the broken leg she suffered on Christmas Day. By 4 p.m., he was still making calls.
"I've pretty much burned my whole day up on the phone," said Roberts, who said he wasn't able to get through to anyone at MTM and didn't get a very "Minnesota nice" response from the people he reached at Blue Cross.
"At this point, I'm ready to take $100 out of my own pocket," he said. "Please just move my mother from Mankato to New Ulm."
MTM spokesman Phil Stalboerger said the company is working quickly to help everyone who is having a problem. But so far, he said, most people got where they needed to go. MTM coordinated 643 trips on New Year's Day and 457 trips the day after, he said.
"We strive for excellent customer service," he said.
The company has reached out to Anderson and assured her that she will have transportation to her next appointment, in February, he added.
In a statement, Blue Cross said "any reports or indications of mis-scheduled rides are absolutely unacceptable and acted upon immediately … We are in discussions with MTM to ensure that our members receive the transportation services they require to get to their appointments."
This isn't the first brush with controversy for MTM, which is based in St. Louis and has contracts across the country. Five years ago, the Legislature stripped the company of its state contract to coordinate nonemergency transportation for Medicaid clients in the metro area. Critics argued that brokers like MTM added an unnecessary layer of bureaucracy, while MTM countered that it had the ability to streamline costs, reduce fraud and keep track in real time of all the clients in transit on any given day.
Despite the Legislature's efforts, metro counties simply began contracting directly with MTM. Lawmakers have spent the past three years reviewing the issue and are likely to propose a new transportation strategy this session.
As a private entity, Blue Cross has the right to make its own business decisions. But the Department of Human Services (DHS) will be monitoring the patients' complaints to ensure that MTM is fulfilling its obligations under law.
"Transportation is an important benefit to our members," sad Nathan Moracco, the DHS acting assistant commissioner of health care. "If there are any systemic issues, we'll be sure to address them with Blue Cross."