Health care upheaval leaves WNC residents with questions

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Health care upheaval leaves WNC residents with questions

As Republicans in Congress attempt to repeal the Affordable Care Act and Mission Health threatens to cancel its contract with the largest health insurance provider in Western North Carolina, thousands of people are wondering whether they will be covered and what the cost might be.

Mountain Projects, a local social service agency that has been able to provide health care navigator services since 2013 thanks to a federal grant, has been fielding plenty of calls from clients asking questions the staff doesn’t have the answers to.

“We’ve helped 6,000 people sign up for health insurance since the beginning of ACA,” said Health Care Navigator Jan Plummer. “And we’re getting a lot of calls from people worried about what is going on.”

Those 6,000 in WNC who have health insurance through the ACA Marketplace likely have a plan through Blue Cross Blue Shield, one of the last remaining providers offering ACA plans in North Carolina.

Not only are those people wondering whether they should even bother renewing their ACA plan this fall, but they’re also concerned whether the policy will be beneficial if Mission Health Systems in Asheville cancels its contract with BCBS.

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Mission vs. Blue Cross

There are nearly 130,000 BCBS patients who have visited Mission hospitals or practices during the last year, which includes patients who have Blue Cross employer-sponsored coverage, State Health Plan, health insurance exchange plan, Medicare Advantage or Blue Cross as a secondary health plan.

If Mission and BCBS don’t negotiate a deal by Oct. 5, BCBS policyholders will have to pay more out of pocket for services through Mission affiliates because it will be considered out-of-network.

Plummer said she hopes the two companies work out a compromise before the October deadline and the open enrollment period for the Marketplace begins.

“This is something that happens in the negotiation process — I don’t know if it’s really going to happen or if they’re working on a resolution, but Blue Cross Blue Shield has had public service announcements on the radio saying they received a termination notice from Mission so it’s prompted people to call us with their concerns.”

Mission issued a press release July 5 stating it planned to terminate its contract with BCBS of North Carolina “if ongoing negotiations fail to reach an agreement” on reimbursement costs for services. Mission’s notice to BCBS established an Oct. 5 deadline for a new contract or else Mission, its affiliate facilities and physicians will be outside the BCBS network.

“What this means for people with BCBS insurance who need services from Mission is that they’ll be out of network and will have to pay more out of pocket to go to Mission,” Plummer said.

BCBS was quick to fire back at Mission with its own press release stating that the requested price hikes from Mission would not be sustainable and expressed disappointment in Mission’s move to terminate the contract instead of continuing negotiations. Mission Health recently renewed its contracts with Cigna and Aetna, but if it doesn’t renew with BCBS, it will be the only health system in the state to not be on the BCBS network.

Since the announcement, the public relations battle has heated up — Mission has been buying full page advertisements in newspapers across the region painting Blue Cross as the bad guy with tag lines like “Our mission is to heal the sick, not arm wrestle insurance companies. Yet that’s exactly what Blue Cross is forcing us to do.” The ads also direct people to www.standwithmission.org.

“With 72 percent of the market in our state, Blue Cross has a history of getting what it wants,” the website states. “It has exercised its power by forcing healthcare providers into ‘forever’ contracts that renew automatically, with zero adjustments to the rates we are paid for providing healthcare services.”

BCBS representatives recently spoke about the issue in a presentation to the State Employees Association of N.C. Board of Governors. BCBS officials contended that Mission is already overcharging them for services, and plan to raise prices even more while more than 40 other hospitals across the state have accepted consistent terms with BCBS to help with customer costs and improve quality.

“Mission has stated to Blue Cross NC that they expect and need an increase from us (from our customers) in order to subsidize their sizable Medicaid and Medicare patient base,” the presentation read.

The entire presentation can be seen at www.seanc.org/assets/10.-Mission-SEANC-Final.pdf.

On the other hand, Mission claims its prices are 23 percent lower than similar hospitals in North Carolina and 7 percent lower than local hospitals in WNC.

“Blue Cross has consistently issued year-over-year premium increases to its customers. Yet it has failed to increase what it spends on its members’ healthcare services accordingly,” Mission’s advocacy webpage reads. “We are asking for a modest, single-digit adjustment to Blue Cross’ payment rates as part of a multi-year agreement. We wouldn’t be asking for these increases if it wasn’t absolutely necessary for our health system — and Western North Carolina residents who depend on our lifesaving care.”

As for how this change may affect North Carolinians who hold a federal plan with BCBS, Mission’s website directs them to contact BCBS to learn more about the impact.

Where to get covered

Even if the contract with BCBS expires Oct. 5, Plummer said BCBS policyholders should still be aware that emergency room services are always considered in network whether it’s at Mission or another hospital.

“If you’re having a stroke and need to get to the ER for medication quickly, don’t hesitate,” Plummer said. “Emergency situations are always in network no matter what.”

Some patients already receiving services through a Mission affiliate may be eligible to continue those services if they meet the Continuity of Care criteria. To be eligible, the patient must be seen by a participating provider prior to the termination taking effect. The patient must be actively being seen by the out-of-network provider for an ongoing special condition and the provider must agree to abide by the BCBSNC requirements for Continuity of Care.

Mission also accepts most other health providers, including Cigna, Aetna, Coventry, United Healthcare, Humana and others.

Plummer also encourages patients to educate themselves on the services provided at other hospitals in WNC outside Mission’s network, including Duke LifePoint hospitals — Haywood Regional Medical Center in Clyde, Harris Regional Hospital in Sylva and Swain Community Hospital in Bryson City. Angel Medical Center in Franklin and Highlands-Cashiers Hospital in Highlands are under the Mission umbrella.

While Mission has been a leader in the region when it comes to cardiac health and services, Harris Regional is working to make the same services available in Sylva. A new catheterization lab at Harris is the latest in a series of expansions for the hospital’s cardiology service line, in addition to hiring several cardiologists. Last year the hospital expanded diagnostic, treatment, and monitoring services, as well as echocardiography seven days a week.

Since Mission announced earlier this year its plans to discontinue labor and delivery at Angel Medical in Franklin and consolidate its women’s and children’s practices from Sylva to Franklin, Harris is ramping up prenatal and pediatrics services in both communities.

Preparing for ACA repeal

On July 28, the U.S. Senate defeated a last-minute bill designed to repeal the Affordable Care Act. In a surprising move, Republican legislators — Sen. Susan Collins, Sen. Lisa Murkowski and Sen. John McCain didn’t follow the party-line vote and helped defeat the bill.

“This is a major victory for consumers throughout North Carolina who can breathe a sigh of relief knowing now that their access to affordable, quality coverage is secure for now,” said Brendan Riley, a political analyst for N.C. Justice Center. “Following the vote, President Trump stated that he will ‘let Obamacare implode.’ However, both data and statements from Blue Cross Blue Shield of North Carolina show that the ACA’s exchange markets are stabilizing, so it will take intentional sabotage efforts by the Trump administration to make this prediction a reality.”

Your guess is as good as Plummer’s when it comes to trying to predict what will happen with the Affordable Care Act repeal and replacement efforts in Washington.

However, Plummer said people needed to continue to operate under the assumption that ACA will still be in place when open enrollment comes back around in November.

“The main thing is ACA is still the law,” she said.

Mountain Projects’ health care navigator grant expires Sept. 1, 2018, but between now and then there will still be people available to help you sign up for a plan on the Marketplace website. In previous years, people have had several months to sign up for an ACA plan, but this year’s enrollment period is only six weeks — Nov. 1 through Dec. 15.

“We encourage everyone to come in now and get their account ready for open enrollment,” Plummer said. “We’re down to six weeks for open enrollment so we’ll be having information go out to people soon and also a press release on how they can to do it themselves.”

The rules on being able to sign up on the Marketplace after Dec. 15 have become stricter as well — only exceptions are made for people who have lost a job, had a baby, gotten married or divorced, or other life-changing events.

Plummer encouraged Marketplace policyholders to make sure they’re up-to-date on their premium payments before trying to enroll for 2018 coverage.

“If you haven’t paid them this year and try to re-enroll, you’’ have to pay back the premiums to reactivate your policy and that is something very costly,” she said.

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