Experts clear up confusion over insurance options
Tuesday, February 04, 2014 10:00 AM
Local healthcare officials have a warning for families and individuals looking to sign up for health insurance on state marketplaces: Buyer beware.
Issues may arise for people living near state borders who purchase insurance through the marketplaces, King’s Daughters’ Health President and CEO Carol Dozier said – especially for non-emergent healthcare procedures.
As the deadline for signing up for insurance to meet the Affordable Healthcare Act requirements for 2014 nears, officials encourage people to be sure to look at their network options for doctors and hospitals before signing up for health insurance policies. Doctors and hospitals may be "out-of-network" on some of the plans offered by the state marketplaces because of state lines.
Issues may arise for people living near state borders who purchase insurance through the marketplaces, King's Daughters' Health President and CEO Carol Dozier said - especially for non-emergent healthcare procedures.
Since some Kentucky residents use King's Daughters' Health services just across the river in Indiana, people purchasing insurance through the Kentucky healthcare marketplace - known as Kynect - should double-check to make sure the plan they select doesn't have a "closed" network.
A "closed" network could limit residents on certain plans to only use doctors within state borders where the insurance is purchased for preventative healthcare.
The same warning goes for Indiana residents who use the state's healthcare marketplace and usually see doctors in Louisville or any other Kentucky hospital or doctor.
In reality, the "closed" network may only affect a few people, Dozier said, but people signing up on marketplace exchanges need to be aware of the issue.
Gwenda Bond, spokeswoman for Kentucky's Cabinet for Health and Family Services, noted some of the plans offered through Kynect do limit providers as with other private insurance plans. Each plan and provider is different, she said, and people should be sure to check out the network listings for each plan to make informed decisions.
"We do really encourage people to review," Bond said.
The majority of insurance providers on the Kynect marketplace do not have closed borders, said Maggie Woods, director of the Kentucky Department of Insurance Health and Life Division. Yet one insurance provider - Anthem Blue Cross and Blue Shield - does.
Other providers may have limited options in their networks though, she said, and people should always be aware of what they are purchasing.
The insurance practice of closed borders isn't illegal, Woods said, but it can cause confusion for new policy holders.
Officials from the Indiana Department of Insurance also warn people to read the policy language carefully when signing up for a new healthcare policy.
Indiana residents living in Jefferson County can browse the state marketplace for health insurance plans from only one provider - Anthem Blue Cross and Blue Shield - right now.
The Anthem plans do limit patients to doctors and hospitals in Indiana for non-emergent healthcare, the Anthem Blue Cross and Blue Shield online provider directory shows.
Several hospitals and doctors located in Indiana are "in-network," and more providers continue to be added. King's Daughters' Health recently announced its participation in the Indiana healthcare marketplace through Anthem Blue Cross and Blue Shield last month.
Private insurance plans purchased through the state marketplaces cover emergent or urgent healthcare procedures and costs no matter which state the emergency may occur, Woods said.
Yet non-emergent procedures such as an MRI, CT scan or elective surgeries would not be covered by insurance providers at "out-of-network" healthcare locations, Dozier said.
Hospitals and doctor's offices should be able to alert patients about potential issues with insurance before a visit or procedure, she said.
Officials said Medicare and Medicaid insurance are accepted across state lines for any healthcare services.
Uninsured Indiana residents may visit www.healthcare.gov to find the state's marketplace for insurance providers. Uninsured Kentucky residents can visit www.kynect.com to find the state-run marketplace options.