Colorado: Anthem/UCHealth fail to reach deal, force tens of thousands to scramble

Last week I wrote about how my friend Laura Packard, along with up to 44,000 others, is in serious danger of losing access to critically important cancer treatment and other services due to a falling out between one of the largest health insurance carriers and one of the largest medical centers in Colorado:

Denver-area Anthem customers on Colorado exchange forced to switch doctors

DENVER (KDVR) — Laura Packard was diagnosed with stage 4 Hodgkins-Lymphoma cancer in 2017. The 44-year-old moved from Nevada to Colorado in 2019 for one reason: the state’s heath insurance exchange that provides affordable options to individuals who otherwise can’t get coverage.

Doctors at UCHealth have continued to treat Packard to make sure she stays cancer-free.

“I can’t go without seeing an oncologist. I’ve only been in remission for a couple of years,” said Packard, who was devastated to learn her insurance carrier Anthem and UCHealth couldn’t reach an agreement for 2021.

“They know you and what you’ve been through and I think if you look at national rankings, it’s pretty clear where people fall. UCHealth has expertise that nobody else offers,” said Packard.

The contract dispute between Anthem insurance and UCHealth means Anthem patients in metro Denver will have to switch doctors if they want to stay in-network beginning Jan. 1, 2021.

Anthem managed to come up with an alternate provider network, but...

“They claimed there would be some kind of great savings but what good it is for people like me if we save a few dollars a month in premiums and then have to pay all that to see our doctor out-of-pocket?” said Packard.

The Problem Solvers have spoken to other patients besides Packard who don’t want to switch to HealthOne but can’t afford the out-of-network fees UCHealth would now require.

“If my cancer recurs and I need the kind of treatment that I can only get at UCHealth, that is hundreds of thousands of dollars and I could die without that treatment,” said Packard.

I crunched the numbers and determined that the number of Anthem enrollees impacted is likely somewhere between 22,000 - 44,000 people statewide.

I concluded that:

The "good" news here (such as it is) is that thanks to Connect for Health Colorado's Open Enrollment deadline being a month later than the federal exchange (January 15th instead of December 15th), Laura and others still have a month to switch from Anthem to a different carrier if Anthem and UCHealth don't manage to work something out and she has to do so.

Unfortunately, it's looking very much like that will be the case. Via an update on 12/21 from the Denver Post:

Denver residents who buy their insurance through Connect for Health Colorado won’t have easy access to UCHealth’s hospital and doctor network in 2021, after the health system and Anthem Blue Cross and Blue Shield failed to come to agreement.

Eight companies sell plans through the state-run individual health insurance marketplace in Denver. Anthem was the only one that included UCHealth in its provider network, but didn’t include the system in 2021 in plans sold in the 10-county Denver metro area. UCHealth remains in-network for some marketplace plans sold in other parts of Colorado, and for Anthem’s group coverage plans.

...Vince Plymell, spokesman for the Colorado Division of Insurance, said people undergoing care for a significant health issue and those in their second or third trimester of pregnancy can request a 90-day extension, so they can set up a smooth transition. It doesn’t apply to people who just want to keep their current doctor for routine care, he said.

Packard had Hodgkin’s lymphoma, which has been in remission since 2018. She still sees an oncologist multiple times a year to check for signs the cancer is returning, and needs monitoring for heart and lung damage from chemotherapy and radiation treatment. Since she isn’t undergoing cancer treatment, she doesn’t qualify for the 90-day extension.

“I have to find a new everything,” she said. “I can’t even imagine someone who’s going through chemotherapy now.”

...Packard said she struggles to understand why people in other Front Range counties can buy insurance with UCHealth in-network and Denver residents can’t. She said she’s frustrated with both parties, because UCHealth had revenue that was well above average last year, and Anthem has a history of brinksmanship in negotiations in other states.

“I think it’s two bad actors colliding, and the patients are getting caught in the middle,” she said.