SMITH CENTER, Kan. – In response to the COVID-19 emergency, President Biden signed an executive order to allow an additional open enrollment period for Affordable Care Act plans purchased through the exchange at healthcare.gov. The new enrollment period will begin Feb. 15 and will continue until May 15, 2021. This opportunity could be an advantage for the uninsured or underinsured in our communities, but the administration at Smith County Memorial Hospital warns that some of the plans on the government website should come with a “buyer beware” label and may leave individuals without any healthcare coverage at all.
“We began to see issues with the plans on the exchange during the open enrollment period at the end of 2020,” said Allen Van Driel, CEO at SCMH. “Insurance companies say they will cover care at specific facilities or from specific providers and we have no knowledge of that company, let alone a contract.”
That contract is the difference between in-network coverage and out-of-network coverage.
When a user inputs their zip code into the insurance finder tool on healthcare.gov, they are likely to see a long list of options listed from lowest monthly fee to highest. Van Driel warns that the low price options may lead to long-term hassle and higher costs overall.
One of Van Driel’s concerns is that once a patient signs up for a plan they are stuck with that insurance until the next open enrollment period.
“A year of out-of-network insurance coverage can be a very big financial burden,” he said.
Individuals who are in relatively good health and, on average, only see their provider at an annual exam may be fine with less coverage. For individuals and families that come to the clinic often, see a specialist regularly or have a lot of prescriptions, an out-of-network insurer could mean high co-insurance fees and a higher percentage of care costs as the patient’s responsibility.
“Users should enter as much information as possible including not only their primary care provider but all the facilities where they regularly see providers,” Van Driel said. “For example, an insurance company may say they cover services by one of our nurse practitioners, but when the user looks at the facilities in-network, neither the hospital nor clinic are covered.”
The plans have created confusion and frustration for more than one patient of the clinic.
“Our providers and patient accounts staff take very seriously the care of our patients all the way from the exam room to the bill they receive later,” Van Driel said. “This means helping to protect our patients and their families from misinformation by insurance companies. These companies are costing people thousands of dollars by misrepresenting their coverage.”
Van Driel goes on to explain that in the last year a new company or two have appeared on the healthcare exchange that do not have contracts with SCMH. They do, however, recognize a specific provider’s credentials and so appear in a list of insurance plans for purchase. The finance team and administration are looking into correcting the problem and have contacted the insurance companies, the credentialing office and the state’s insurance commissioner in Topeka to try to find a solution.
“We started working on a solution as soon as we found the error on the government website, but have not been able to correct it at this point,” Van Driel said. “We’ll continue to work and make contacts until this is resolved, but with the new open enrollment period we are concerned that even more of our patients will be impacted by the inaccuracies.”
The patient accounts team at SCMH is led by Laura Zabel who tracks all the contracted insurance providers and tries to help explain billing to patients when they have questions.
“We do our best to get ahead of issues before they become a financial burden for a patient,” Zabel said. “The best advice I have for patients is to contact us before purchasing a plan on the exchange. While we cannot and do not give advice about which plan is best for their needs, we can answer questions with regard to which insurance companies we contract with.”
Zabel notes that there are several things to consider when purchasing insurance.
“We want our patients to have affordable options, however, they really need to dig deep and contact the insurance company they are reviewing,” Zabel said. “Ask questions with regard to the in-network and out-of-network care, when signing up. Different stages of life, medical history and total cost all play a part in what a patient should consider before choosing a plan.”
Van Driel agrees that asking for help can make the difference between overpaying and being underinsured.
“Health insurance keeps getting more complicated and more competitive,” he said. “There is always going to be one company that promises the best deal for the least amount of money. As with anything else, it’s best to check before you buy.”