Yes, you have insurance. No, you can't see the doctor.

By BETH SLOVIC, Chronicle Staff Writer

Some physicians in Bozeman are not willing to talk about this.

Certain patients are not treated in their offices, and it's not for lack of health insurance.

Laura Wells, 29, realized this in May when her 3-year-old daughter, Hadley, was losing her silky, strawberry blonde hair in clumps.

Hadley's primary-care doctor told Wells, who is a stay-at-home mom in Bozeman, to take the toddler to a specialist.

In theory, this should not have been a problem.

Hadley and her sister Kassy, 21 months, both have health insurance through the Children's Health Insurance Program, the publicly funded plan covering children in low-income families.

Wells and her husband, a graduate student at Montana State University who is also a part-time limo driver, qualify for the program because they earn less than $29,000 a year, an income that amounts to 150 percent of the federal poverty level for a family of four.

The trouble is that Hadley needed a dermatologist. And none of the four practicing dermatologists in Bozeman accepts CHIP or is willing to explain why.

"If someone could give me a good reason, I would be OK," Wells said.

Barriers beyond waiting lists

Next month, state officials will unveil a new advertising campaign to encourage eligible parents to enroll their children in CHIP.

Despite this blitz, barriers exist today that prevent children with CHIP coverage from getting the special care their primary physicians determine they need. Area clinics do not offer specialists.

The state's advertising campaign, which will feature a public service announcement from Gov. Brian Schweitzer, follows a December announcement by state health officials that CHIP was poised to expand.

Today, about 12,000 kids in Montana have health insurance through CHIP. But thanks to an increase in funding from the 2005 Montana Legislature, the program grew by 3,000 slots. Now there is no waiting list for families who want to sign up.

At the time of the announcement, Joan Miles, director of the Montana Department of Public Health and Human Services, said CHIP was a "sensible solution" that could provide "peace of mind and financial security for working parents and their families.

"Parents who think that affordable health coverage for their kids is an impossible dream should explore CHIP as a solution," Miles said in the press release.

What Wells and other families in Bozeman have since learned is that having health insurance for their kids is not enough.

If some local specialists won't accept CHIP, these parents cannot easily access the care their kids need.

Pat Wanderer, who manages the practice of Dr. Alan Wanderer, a Bozeman allergist who does accept CHIP, said physicians face a financial quandary when it comes to seeing patients with CHIP or, for that matter, Medicaid and Medicare.

Typically, Medicaid and Medicare pay doctors only half of what they bill.

But CHIP is substantially more generous, local doctors have said. In Montana, CHIP is managed by Blue Cross Blue Shield, which pays doctors 20 percent less for seeing CHIP patients than it does for privately insured patients.

The federal government contributes 80 percent of the cost of running the program, and the state contributes the rest.

In addition to the partial payments from government-funded programs, the cost of doctoring is high and getting higher, several local physicians have said.

"We do have to be able to pay our overhead and medical malpractice costs," Pat Wanderer said. "A lot of practices just can't afford to (see everyone); we're grateful we are."

The result is that people, whose financial resources are already strained, have to travel some distance to get their kids to certain specialists.

One 57-year-old grandfather who is raising three of his daughter's children, said he will have to drive to Helena to have a nickle-size wart frozen off his grandson's knee.

The grandfather, who lives in Bozeman but did not want to be identified, said no dermatologists in town would agree to see the boy.

Spending money to save money

In addition to the four dermatologists in town, neither of the ear, nose and throat specialists in Bozeman accepts CHIP.

Wells, whose oldest daughter was eventually treated, confronted this obstacle in August when her youngest daughter's chronic ear problems flared up.

Before moving to Bozeman last year, the Wells family lived in Des Moines, Iowa, where Kassy, in December 2000, had tubes implanted in her ears. The tubes were supposed to drain the fluid causing pain in Kassy's ears, and they were supposed to eventually fall out.

But they have not, and in August, Kassy contracted another ear infection. In September she got sick again.

By then, the tube in the girl's right ear had dislodged and a permanent blood stain formed in her ear, Wells said.

But because the ear, nose and throat doctors in Bozeman do not accept CHIP, Wells has had to seek help elsewhere. Eventually she ended up in Livingston, where specialists from Billings Clinic hold office hours.

Kassy is scheduled to follow-up with a doctor from Billings in March, but seeing him means Wells or her husband will have to drive all the way to Yellowstone County.

As a result, the family will have to pay for gas and lost wages, all in order to avoid paying 100 percent of a local specialist's bill.

Essentially, they will be have to spend money to save money.

Limiting care and answers

Far more doctors in Bozeman do accept CHIP than do not. But even those who will see CHIP patients limit the number they will see or only treat current CHIP patients.

And the doctors who won't take those patients also won't talk about it.

After repeated efforts to reach Dr. Charlotte Kutsch, her receptionist finally said the doctor was "not interested" in explaining why she does not accept CHIP.

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