Some Coloradans Face Drops In Health Insurance Coverage Heading Into The New Year

DENVER (CBS4) – Amidst a pandemic, a number of Denver metro area residents who buy their health insurance through the state marketplace, Connect for Health Colorado, will have to look for new doctors heading into 2021. That's because Anthem Blue Cross and Blue Shield and UCHealth were unable to reach a contractual agreement regarding individual health insurance plans for the Denver metro area.

For those plans, Anthem will now contract with HCA HealthONE, and UCHealth providers will no longer be in network starting in January.

Before this change, Anthem was the only company on the state marketplace to sell a plan for people living in and around Denver where UCHealth was in network, the Colorado Division of Insurance confirmed. Residents of other parts of the state can still buy plans with Anthem where UCHealth is in network.

"It feels like if they can come to an agreement for every other place in the state, why can't they do it for metro Denver?" asked Laura Packard, a cancer survivor and Denver resident.

In 2017, Packard was dealt a devastating hand.  At first doctors thought the cough she developed was related to pneumonia, but later testing confirmed a diagnosis of stage 4 Hodgkin's lymphoma.

After months of chemo, Packard beat cancer in 2018, and then a year later, knowing she'd be in for years of follow up visits with doctors, moved to Colorado for affordable health coverage from the state marketplace.

Packard still sees several UCHealth doctors regularly, including her oncologist, but that could soon change as they will be out of network.

"My oncologist, who I just saw last Monday wants to see me again in June," Packard said. "She's not covered by my policy, so do I see her and just pay for everything out of pocket? Do I try to find another oncologist that maybe doesn't have the expertise that she has?"

Sara Share, a Denver resident, is also trying to figure out what to do next.

"It's frustrating," Share said. "Here's the health care that I need, and it's sort of inaccessible to us."

More than three years ago she was diagnosed with ovarian small cell carcinoma and underwent surgery to remove a 10cm mass from her ovary. According to Share, who is now in remission, few doctors in the country are experienced with treating the rare form of cancer, but she and her husband found one at UCHealth.

Share was laid off earlier this year due to the pandemic and lost the coverage she had through her employer. She's currently enrolled in CORBA and plans to keep it that way so she can keep seeing her doctor, since no companies in the state marketplace offer plans where UCHealth is in network for Denver residents.

"My doctor wants to continue to treat me, but he's not the decision maker in this regard," she said. "We're all just doing the best we can and hoping other people consider the impact of these decisions."

Vince Plymell, Assistant Commissioner for Colorado's Division of Insurance, tells CBS4 it is not unusual for insurance companies' networks of health care providers to change from year-to-year. The state agency reviewed the new contractual agreement between Anthem and HCA HealthONE and found it provides an adequate system of providers for members, as well as lower premiums.

"They were also, at least in the Denver metro area, able to bring premiums down a little bit over 20%," said Plymell.

Tony Felts, a spokesperson for Anthem tells CBS4 the company's new network and set of plans have "virtually the same benefits as last year's Anthem individual plans," but with lower monthly premiums. UCHealth was invited to be a network provider in this new plan, however, they chose not to participate, he said.

On the other hand, Dan Weaver, a spokesperson for UCHealth, said the company wasn't notified of the change until the fall, which is why an alternative plan won't be ready for the exchange by Jan. 1.

"We understand that this is difficult for many of our patients, and we are working as quickly as possible to explore options with other insurance carriers to create a plan that includes UCHealth and University of Colorado School of Medicine locations and providers. We hope that a new plan will be available with an insurance carrier on the exchange later in 2021 that will include UCHealth in its network," Weaver said.

According to Plymell with DOI, current Anthem members can apply to continue seeing their doctors for a short period of time in what's called "continuity of care." It's typically reserved for people in life-threatening conditions, undergoing a course of treatment for a serious acute condition, a chronic condition or a life limiting illness, or in the second or third trimester of a pregnancy and is typically limited to 90 days.

Packard tells CBS4 she was recently approved, but worries it won't be enough to fix her problem.

"So, I have the 90 days, but I need to see my oncologist in June, and being able to keep my doctors through March 31 doesn't help me," Packard said.

If people experience any difficulties with the process or don't hear from Anthem in a reasonable time, they can reach out to the Division's Consumer Services division for assistance - 303-894-7490 / 800-930-3745 (outside of the Denver metro area) / DORA_insurance@state.co.us.