Medical Insurance Coverage Inaccuracies Frustrate Consumers


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In an attempt to cut down on administrative paperwork and back office hours, the new plans under the Affordable Care Act will go up for Auto Renewal when they reach their expiration date for each consumer. The renewal is not as straight forward as you might think. Read this document to get in the know on what to expect when your plan comes up for its next cycle.

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Medical Insurance Coverage Inaccuracies Frustrate Consumers

  1. 1. COVERAGE INACCURACIES MRS © 2014 Page 1 Coverage Inaccuracies Frustrate Consumers
  2. 2. COVERAGE INACCURACIES MRS © 2014 No one wants to leave the comfortable neighborhood feel of what they know to be familiar. With the new healthcare law, however, many people have been forced to leave their long- time doctors and insurance plans because either it became too costly to stay or because the plan was no longer available. " Once change has occurred, the least consumers expect is to get accurate information when looking for a new provider so they can choose a new one based on factors such as location and ratings. " Unfortunately, the lists of in-network providers offered by the insurers haven’t proven to be totally clear or reliable. Rather than receiving timely care and coverage, many patients are receiving the runaround and costly bills. " Nearly 2,000 complaints were filed regarding inaccurate or difficult enrollment procedures in California. Consumers say they are not receiving paperwork and insurance cards, and they are having difficulty finding a provider that will even take their coverage due to dwindling networks. " Insurance companies say they narrowed networks in an effort to keep premiums at a minimum; however, the resulting confusion has caused uproar, unexpected bills, and lawsuits. " Page 2 California Consumers
  3. 3. COVERAGE INACCURACIES MRS © 2014 Mark Morgan, Anthem Blue Cross president, said, "These narrow networks are making a huge difference in terms of affordability. We found in convincing numbers that people value price above all else." " Some say their new provider won’t accept their insurance plan, however, because they claim they weren’t supposed to be listed as a provider in that network in the first place. " One California woman battling breast cancer thought she had done her due diligence. She was informed the day before a scheduled lumpectomy that it wouldn’t be covered at the facility after all. " The patient found it too risky to wait, so she proceeded with having the lump removed so she could be on the road to recovery. " The insurance company, because she had notice (even if it was just one day), will not cover the $8,000 bill she received. " This is just one story of many in California where patients have been blindsided even after taking extra steps to ensure they would be covered. " The California Department of Managed Healthcare launched an investigation with both Anthem Blue Cross and Blue Shield of California to ensure that they are in fact upholding the law Page 3
  4. 4. COVERAGE INACCURACIES MRS © 2014 regarding provider lists as well as making way for patients to receive treatment in a reasonable timeframe. " Steve Shivinsky, Blue Shield of California Spokesman said, "People need to be very diligent in deciding where to go. We are trying to do our part to educate people, but it's a big task when the market has been totally turned upside down." " Even though it seemed like a lot of complaints were being received, a representative said that the number was small compared to the number of enrollees. " California isn’t the only state struggling to figure out who their providers are. These issues are widespread throughout the country. " Even though Connecticut has had a relatively smooth transition into the world of Obamacare, locating providers has proven to be a noticeable struggle. " Kevin Counihan, Access Health’s CEO, said, “There remains confusion, I think, about the networks. Everybody’s sensitive to it. It’s clearly a big member issue.” " Some patients have verified coverage and made appointments ahead of time and were still turned away once they arrived at the doctor’s office. Page 4 The fact that we have such a high volume of people searching for providers is kind of shining a spotlight on an issue that we need to remedy. - Victoria Veltri Connecticut Consumers “
  5. 5. COVERAGE INACCURACIES MRS © 2014 “The fact that we have such a h i g h v o l u m e o f p e o p l e searching for providers is kind of shining a spotlight on an issue that we need to remedy,” Victoria Veltri, a healthcare advocate, said. " One of the worst areas of confusion is thought to be due to irregularities of the biggest companies offering plans on C o n n e c t i c u t ’s exc h a n g e . ConnectiCare and Anthem Blue Cross and Blue shield do not use the same networks for plans on the exchange as they do off the exchange. " This, in addition to the fact that one of the insurers had ambiguously labeled provider information on their website, only served to add confusion to consumers during their search. " Veltri did say that patients that received care from an out-of-network provider because the insurer listed them as in-network were advocated for and the companies are requested to cover the visit. She did say that the carriers usually acquiesce to such requests. " She also said, “My immediate concern is to make sure the lists are accurate and to the degree people have purchased based on inaccuracies in lists, we need to make sure those people, if they complain, are informed of their options, including changing plans.” " Veltri also mentioned that just because some doctors are accepting a plan at a practice does not mean all doctors at that practice do. Three doctors may accept a plan while one does not, so she said it is important to be certain that each doctor is separately researched to see if they accept the insurance plan. " " " Page 5
  6. 6. COVERAGE INACCURACIES MRS © 2014 Annette Frey, a New Yorker who beat lung cancer, had her policy cancelled when the Affordable Care Act rolled out, and she had to purchase a plan on New York’s healthcare exchange, NY State of Health. " Frey claims her insurance “was almost unusable” even though it was the most expensive one on the exchange and listed her doctor as being “in-network.” Not only was the in-network list of providers incorrect, some of the locations were even inaccurate. " She needed to see the doctor. She also needed specialist referrals and checkup approvals to keep an eye on her progress. Instead, Frey waited weeks to hear whether or not her doctor would even be available for her to see. " During the ordeal, she was given conflicting information from the insurance company and the doctor’s office and says she made nearly 200 phone calls to secure the services she signed up for in the first place. " “I signed up for United Healthcare specifically because of the doctors I needed that were ‘in network’ – something I went to great lengths to verify before signing up,” Frey said. " When Frey finally got confirmation to see her doctor, United Healthcare denied the claim, stating that her doctor was not in-network (even though the doctor’s name was on her insurance card). " Page 6 A Cancer Survivor’s Struggle
  7. 7. COVERAGE INACCURACIES MRS © 2014 United Healthcare said Frey’s situation is rare and that it is in no way a reflection of how the company operates as a whole. " “Ms. Frey’s doctor has opted not to participate in individual exchange networks. We apologize to Ms. Frey for any inconveniences she experienced as this does not reflect how we like to support our members.” " Notwithstanding her self-proclaimed identity as “...a tough New Yorker,” Frey has become exasperated trying to get the care that she needs. “I don’t think people understand the stress. My insurance is making me sick. I can’t do this every time I need to see a doctor.” " It isn’t just the patients dealing with the confusion. Those who purchased their plan on the exchange are told to specifically ask if they accept that particular plan if purchased from the exchange. " They are also told that the doctor’s office may not have the answer. It’s not enough to know they accept Anthem Blue Cross (or any other plan); they have to know whether or not they accept the Anthem Blue Cross that was purchased from the exchange. " Furthermore, patients can call a doctor’s office and many times the staff can’t tell whether or not they accept that patient’s particular plan, because many providers don’t deal directly with the insurance companies. Instead, they are part of larger organizations and third parties who deal with contracts. " Lisa Folberg, vice president of medical and regulatory policy at CMA, said that “many physicians have been ‘opted in’” to plans unknowingly. Some “all-products clauses” in contracts signed between physicians and insurance companies exist. " Page 7 Confusion Among Providers
  8. 8. COVERAGE INACCURACIES MRS © 2014 Once signed, the agreement is that the doctors who accept one plan from the insurance company also agree to accept all of their other plans. A good number of physicians overlook that part, and as a result they become part of networks and plans of which they are completely unaware. Tim Tracy, a Connecticut insurance broker at Farifield, said, “Your doctor may think they take Anthem and ConnectiCare, which they do, but these exchange networks are completely new and different, and they are smaller than networks already established.” " Patients can’t say whether or not a provider list is accurate; however they can take steps to cover themselves. By making phone calls, taking names, and getting approvals in writing, the patients who must get care can at least have some type of proof that they were told by the insurance company that they would be covered. " We can only hope that, during this second year of Obamacare plans, these detrimental kinks will be worked out and that the information will become more reliable. Page 8 Call 855-203-7058 or Click the Button to Visit Looking to Dispute Medical Bills? Your doctor may think they take Anthem and ConnectiCare, which they do, but these exchange networks are completely new and different, and they are smaller than networks already established. - Tim Tracy “