Reprinted from HEALTH PLAN WEEK, the most reliable source of
objective business, financial and regulatory news of the health insurance
industry.
By Diana
Manos, Senior Reporter
October 30, 2017 Volume 27 Issue 38
Two senators are pushing America’s Health
Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA)
to intervene in claims issues following the Oct. 1 Las Vegas shooting, which
left 59 dead and more than 500 injured. But the request is difficult to comply
with and somewhat out of the norm when it comes to claims practices following a
disaster, says one insider.
Chantel Sheaks, a director at PwC who
specializes in benefits, tells AIS Health that she has not encountered health
plans doing what the senators have requested. “I have never heard of this, and
I find it difficult on how you would actually verify,” she says. “Also, most
policy documents would not provide for this, and I think it would be difficult
to amend the policies and file with the states.”
Sens. Catherine Cortez Masto (D-Nev.) and Dean
Heller (R-Nev.) argue in their Oct. 12 letter to AHIP CEO Marilyn Tavenner and
BCBSA CEO Scott Serota that many of the victims had traveled to Las Vegas from
other states and will need help from health plans to deal with potential
out-of-network charges, copays and deductibles for the care they received
following the shooting.
“[W]e fear that victims of this tragedy
currently seeking badly-needed health care in the community could be hit with
costly, out-of-network charges,” the senators said. “It is our hope that
insurance companies will fully comply with the spirit of the Public Health
Service Act and do whatever they can to support recovering families and waive
any charges that may typically apply.”
Masto and Heller acknowledged that health plans
have already set terms on copays and deductibles, but asked them to “thoroughly
review these policies in light of the extenuating circumstances faced by
victims and their families.”
The senators also encouraged insurers to
consider additional initiatives that could ease “the costly burden of health
care for victims of this tragedy.”
AHIP spokesperson Cathryn Donaldson says the
organization has not yet completed its response to the inquiry. In the interim,
she tells AIS Health, “We offer our sincere condolences to the families and
friends of the victims and those injured in this horrific, tragic event. Health
plans have extensive experience with emergency and disaster situations, and
have procedures in place to meet consumers’ needs immediately and in the long
term. With each crisis, plans coordinate with local, state, and federal
officials to ensure access to care is protected for Americans affected by these
events.”
“We are reaching out to our member plans to
evaluate the potential impact and to learn more about additional efforts they
are taking to support those in need. This includes outreach beyond our Nevada
plans, as many of the victims traveled to Las Vegas from other states and
therefore will need follow up care in their own communities,” Donaldson says.
In September, health plans in Texas responded to
a call from the Texas Dept. of Insurance following Hurricane Harvey to “waive
penalties and restrictions” on enrollees when they get “necessary emergency and
nonemergency health and dental services out-of-network as a result of the
disaster” (HPW 9/4/17, p. 1). Amerigroup Texas, which covers about
850,000 low-income Texans, eased provider network restrictions for its members,
while Cigna Corp. and Aetna Inc. allowed members to renew prescriptions early.
Karen Kees, a spokesperson for the Florida
Office of Insurance Regulation, tells AIS Health that the Florida agency did
not issue a request for health plans to ease restrictions following the June
2016 mass shooting in the Pulse night club in Orlando, which killed 49 and
wounded 58.
BCBSA did not respond to queries from AIS Health
about the inquiry.
Read the Masto-Heller letter at http://bit.ly/2xhuzGW.
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