State: you’re covered by providers who can’t provide
Washington State is changing its Basic Health Care Program coverage, and the state is telling Klickitat and Skamania County residents who were on that program to expect coverage from companies that do not yet provide insurance coverage here.
Klickitat Valley Health (KVH) has had some patients who were on Basic Health and got blindsided by the news that they were going to be covered by one of two companies that don’t have coverage in place yet.
“One of the things that is a criteria for plans to bid on a particular county population,” explains KVH CEO John White, “is that you have an adequate provider network, meaning hospitals and doctors that can see your patients if they signed up with you. That is called network adequacy, so typically the plans had to say to the state, ‘Dear State, I am bidding on the healthy options and basic health plan specifically for Klickitat County and we have the following hospitals signed up, we have the following doctors signed up, so if patients are assigned to us, they can get care where they live.’”
Two insurance companies—United Health Care and Centene—have been identified by the state as taking over for Basic Health, even though neither had the network adequacy required and neither has been signed to provide converage by any medical facility in the county.
“They were awarded the bid for Klickitat County,” White says. “However, neither Skyline nor KVH nor our physicians, nor the North Shore Medical Clinic at Skyline—and those represent 99 percent of the healthcare in Klickitat and Skamania counties—none of us have signed up with United or Centene.”
How did the state come to give this information? “This is pure speculation,” White says, “but my sense is that Klickitat is so small along with the number of other counties involved that they didn’t pay much attention to what happened. I think they probably took whatever plans wrote to them and said, ‘Fine let’s move on, we’re not worried.’”
Others also speculate that with a bloated bureaucracy and tight deadlines, the state may have been time pressured into a move that made no sense. “The state held a deadline for the transition from the old plan to a new and they just gave us a couple of months,” White says. “So the plans came to the hospitals, and said, ‘Here are these contracts, sign them so we can get people enrolled.’ I mean, we just don’t rush to sign something.” White says it takes time to assess potential new providers. “We’ve never met you before,” he says of the companies, “and if we sign this today, we are going to have to live with it for the next three years, and if it’s disastrous in some way for us, we would have really done our community and the hospital a disservice.” There is no requirement from the state that forces any hospital to sign with any insurance provider, so that decision remains in the hands of hospitals and medical facilities.
The matter is being taken to state officials and area legislators, some of whom have promised to pursue it.
“Cindy Robertson, who is the Executive Director at the North Shore Medical Group, has been active in responding with the health care authority,” White says. “She’s saying, ‘Whoa, time out, guys, look what you are doing here—you don’t have the network adequacy. Why did you assign these counties to the plan in the first place? There is no network, and we know because we have asked everybody and nobody has signed up.’ We can’t see whether the state thinks maybe Centene and United are in Yakima and maybe they think that is adequate access for people in Goldendale. It doesn’t make sense to me.”
While the number of residents affected by the mixup in Klickitat County is only 334 people, White says they matter, and health care needs to be about the patient. As the matter gets cleared up, affected patients can still come in for care.
“We’ll make sure if you need care, you will get care here,” White says, “and we will make sure it’s not totally on your shoulders, meaning it’s not private pay; it’s on a network benefit that you can get from United or Centene until the contracts are signed at some point in the future.”