Blue Cross Blue Shield pulls coverage in rural areas

It started as a low rumble, then spread like wildfire across the county amongst seniors. Throughout the never-ending amendments and re-designing of insurance plans, Sanders County seniors found out that they were no longer be covered by Blue Cross/Blue Shield of Montana’s (BCBSMT) Medicare Advantage Plan, as of October 4. The insurance provider chose to drop coverage in 31 rural Montana counties, keeping only nine more populated areas in their network – with a redesigned plan, featuring less coverage.

To add to the confusion, Humana began offering their comparable plan to eligible Sanders County seniors through their marketing channels – the only hang-up in that situation: Clark Fork Valley Hospital (CFVH) is not listed in their provider network. “Our concern is with our seniors who may not understand the consequences of being out of network with their Medicare plan,” said CFVH’s chief financial officer, Carla Neiman. Neiman caught wind of panicking seniors, some of whom might not understand that they could be sold the insurance plan only to find out any care they received locally would not be covered.

Neiman explained that CFVH has been working on behalf of their patients, “Since finding out that Blue Cross was exiting the local market, we have been contacted by Humana and we will be endeavoring to negotiate a contract with them, but these matters take a significant amount of time and effort to work through and, unfortunately, open season for Medicare has already started.” She added, “I want to remind the community that two years ago when Clark Fork Valley Hospital ended its contract with New West Medicare, we made certain that we had another Medicare Advantage product relationship in place with Blue Cross and made significant efforts to keep our patients informed throughout the process, sending letters and placing information in the local papers.”

After hearing the uproar from seniors, Neiman has been moving to clear the air and CFVH’s name, as rumors were implicating that somehow the hospital was involved in dropping their coverage, “I cannot comment on why BCBSMT chose to do this, only they can explain that.” Their Helena offices did not provide a comment by the Ledger’s time of print.

“Anyone in Sanders County who has been insured by Blue Cross Medicare Advantage has been thrust into uncertainty by their decision to exit the market with virtually no forewarning, Neiman explained, “If we had notice of their plans, we could have reached out to Humana (for contract negotiations) earlier.” She estimated that approximately 700-800 Blue Cross Medicare enrollees in Sanders County lost coverage.

“We want to take care of our Medicare patients and will do whatever is reasonably possible to work through this situation. However, we can't control what Blue Cross is doing and we had no advance notice to start a dialogue with Humana,” Neiman added. As to how ethical it was that Humana jumped in to begin marketing in a non-network area, the company was probably following the “see a need, fill a need” philosophy of capitalism, “In all fairness, Humana had no warning this was going to happen, either,” noted Neiman, who offered the advice that local seniors could still enroll in traditional Medicare, which includes a Part B premium, co-pays and deductibles. Hospital financial specialists can help seniors find out if they are eligible for the hospital’s plan based on household income. The Sanders County Council on Aging is qualified in assisting seniors and give advice for best insurance options outside of the hospital’s in-house plan.

Neiman explained that if seniors chose to go with the traditional Medicare option, they should be aware it comes in parts. “Medicare Part A covers inpatient care and does not require a premium. There is a deductible per-inpatient stay. Medicare Part B covers outpatient care, including doctor visits, and requires payment of a monthly premium. There is also an annual deductible and coinsurance of 20 percent of the Medicare allowable fee. A Medicare supplement will cover the deductibles and coinsurance for Medicare A and B. Medicare D refers to drug plans, which are available separately and cover the cost of prescription drugs, with deductibles or co-pays, depending on the plan benefit. Big Sky Rx is a state program that helps Montana residents on Medicare with incomes below $24120 (single) or $32480 (2 person household) to pay the Medicare Part D premium.

President Trump’s recent announcement regarding changes to healthcare came just after BCBSMT’s decision to back out of rural Montana counties, but the insurance company may have seen which way the wind was blowing and moved proactively to salvage what they could in the freshly unstable healthcare market. “I do know there has been increased uncertainty in all of the healthcare insurance markets with the ongoing battles in Congress over "repeal and replace" as well as the subsidies for Affordable Care Act insurers which President Trump recently made an order to discontinue,” said Neiman, but she noted that BCBSMT’s decision may have had nothing to do with the political climate, and only BCBSMT could answer that.

“We will do whatever we can to put an alternative in place, but the timing is not optimal given the fact that open season for Medicare enrollment has already started,” said Neiman, “Unfortunately, we were given no warning and we have not had the time to work to arrange an alternative. We highly value our Medicare patients and their continuity of care is extremely important to us. We will keep the community posted as anything develops.”