Obamacare Clusterfuck: Hospital sues its state commissioner over not being included on Exchange plans.
Seattle Children’s filed suit Friday over the state Office of the Insurance Commissioner’s “failure to ensure adequate network coverage” in several health plans being sold through the state’s new online insurance marketplace, called Washington Healthplanfinder. ... Families that enroll in those plans could face significantly higher cost-sharing amounts they have to pay if they seek care at Children’s rather than at in-network providers.
Exactly as I've been saying.
Children’s officials say they are worried that families may sign up for coverage without realizing that the pediatric specialty hospital is not in most of the plans’ networks.
Ayep. People may sign up for coverage, not realizing that most of their area hospitals are not included in their provider lists. It is irresponsible that the Insurance Commissioner doesn't make this apparent for people, given that it is a NEW PARADIGM.
The lawsuit underscores a concern that has emerged in Washington state and elsewhere that many health plans sold through the exchanges may have “narrow networks” of providers compared with those offered in commercial health-insurance products.
Children’s officials say the hospital’s exclusion from the exchange plans represents a significant change for the pediatric hospital, which has typically been included in most health plans in the state’s commercial market. “The notion that a major insurance plan is going to exclude us from their network is truly precedent-setting and represents a new level of degradation in children’s access to care,” said Dr. Sandy Melzer, the hospital’s senior vice president and chief strategy officer.
Dr. Melzer, you are channeling me. You can say the same about all of the rest of the hospitals that have been dis-included from Exchange plans nation-wide. Children's Hospital does not just serve Seattle. It serves the entire Northwest. It does child bone marrow transplants. It treats the bubble boys and girls. I can't find the link now, but I read last night that half of its patients are Medicaid recipients. This is not about being a fat cat.
Insurers say they are trying to balance the need to offer adequate networks of providers with market demand for affordable health insurance. “Affordability is still the single most important concern,” said J. Mario Molina, president and CEO of Molina Healthcare, which is offering exchange health plans in several states, including Washington.
Well if it's about affordability, then why don't you actually insure people, Mr. Molina? (See all of my posts about the dangers of limited provider networks.) Plans with limited provider networks effectively do not cover catastrophe or severe illness in any way that you can count on. Covering catastrophe is what insurance is about.
[Insurance Commissioner's Office Response:] “We are reviewing Children’s petition to see what lies at the heart of their concerns and will see how it gets resolved through the legal process,” she said.
[Headslap] This is the same kind of tripe I get when I write to our commissioner. Insurance Commissioner = PR Apparatus for the ACA.
I am hoping that this case brings the issue to the forefront in a way that little me with my hair on fire will never be able to. I fear, though, that Children's will get what they want and walk off, leaving people thinking that everyone is okay now.
I would like to file a lawsuit on behalf of my state citizens to require that the Insurance Commissioner rate these plans based on provider network, to inform the public in a real way about what they are buying. I have no money for this, but if you have ideas about someone who would help me in a pro bono way, let me know.
Again, this is not about fixing ONLY my state. It is about raising awareness nationwide, using an example from my state.