As of 2018, Bartow County has just one Affordable Care Act carrier — Kaiser Permanente.
That poses a problem, Cartersville Medical Center Chief Financial Officer Benny McDonald said, because CMC is not contracted with Kaiser — nor are many health care providers within the local community.
“From what I understand,” he said, “there was only one physician in town that’s in-network.”
Rather, Bartow residents with coverage through the Marketplace have had to travel out of the county for in-network care.
Former CMC CEO Keith Sandlin told The Daily Tribune News earlier this year that the hospital had attempted to join the Kaiser network for several years, only for the carrier to repeatedly refuse to sign a contract.
“So what Kaiser appears to be trying to do is to steer Bartow County residents out of Bartow County into Cobb County to access their facilities there,” Sandlin said.
Heading into 2019, however, Bartow residents seeking health care coverage through the Marketplace will have another carrier option — Blue Cross Blue Shield of Georgia, which officially rebrands as Anthem Blue Cross and Blue Shield in January.
“They were in it for a couple of years, then last year they dropped it for our county and several other counties around the state. But then they decided to come back in,” McDonald said. “Patients or residents of Bartow County now have an option to choose a plan that includes their local doctors and includes their local hospital, so they don’t have to travel down to Kennesaw for treatment.”
McDonald said the hospital did not engage in any discussions or negotiations with Anthem about returning to Bartow.
“I think it was something they looked at and saw it as an opportunity to come back into the Market and provide a service that was needed,” he said. “I’m sure they heard about it from the patients who had their coverage the years prior — I think they’ll pick up quite a few because, again, people don’t want to travel.”
McDonald recalled fielding many phone calls this year from patients upset by the lack of in-network coverage.
“People were calling, ‘Where is Anthem? Why are they leaving?'” he recollected. “Of course, I really didn’t know the answer. I just know they chose not to offer in our community anymore.”
That lack of an in-network ACA carrier, he said, had a palpable impact on the hospital. Over the last year, McDonald said the amount of uninsured patients at the hospital increased over 8 percent.
“A lot of that has to do, I think, with folks who have said maybe they won’t take the coverage or they’re not going to make the drive, they want to use their doctors that are here instead,” he said. “I had a couple say they’d just go without and pay the penalty — they preferred to do that rather than travel and stay with their local docs.”
Having Anthem as a Marketplace carrier is “huge” for Bartow, McDonald said. Individuals in the community currently unable to see their local physicians will have an opportunity to start receiving services from their regular health care providers again starting in January.
“I would think that just about every one of our physicians are in-network with them,” he said. “I don’t know one of our doctors that’s not in-network … I would be surprised if any are not in-network.”
McDonald said that in-network coverage will extend to some of CMC’s auxiliary services, including its new urgent care facility on Main Street which is scheduled to open in February.
Anthem, however, isn’t the only ACA option for Bartow residents. Kaiser Permanente is still a Marketplace carrier for 2019, although they remain out-of-network with CMC.
“We still treat Kaiser patients on an emergency basis,” McDonald said. “If they come into the E.R., we take care of them like we do anybody else and then once we stabilize them, then we’ll talk to Kaiser and they let us know if they’ll let us keep the patient here or whether they want us to transfer them.”
Access to Marketplace coverage is especially important for patients who fall into “the gap,” said CMC Patient Access Director Amanda Owens, referring to individuals who may be out of work yet not old enough to qualify for senior health benefits.
“We see a lot of that in the retired community. They’re not old enough to draw Medicare so this allows them coverage,” she said. “It’s a big deal for our community. It’s going to allow those patients that are uninsured to become insured and it’s going to help them with elective services versus emergency services.”
That’s something McDonald said he can attest to from personal experiences.
“I have a friend of mine who’s retired who gets his insurance through [the Marketplace], and if it wasn’t for that, he wouldn’t have coverage — he has a sleep disorder, and prior to the Marketplace coming out, he couldn’t get coverage,” he said. “What he pays is very affordable. His out of pocket the first year was $500, that was it, and after that, everything was covered.”
McDonald said CMC is hosting an enrollment opportunity event on Nov. 29 from 3:30 to 7:30 p.m in Classroom 2 of the facility at 960 Joe Frank Harris Parkway in Cartersville.
Among those slated to be on hand for the event are Bill Blair, president and owner of Cartersville-based Blair & Associates, Inc., and local insurance broker Carter Shaw.
“Members of the community can come on by and if they have questions about signing up for the Marketplace or they actually want to go through the process of signing up, we’ll have people here that will help them,” he said. “All we ask is that they call and make an appointment [and] we’ll set them up with 30-minute sessions.”
Appointments can be booked by calling (678) 535-6919. Open enrollment for 2019 Marketplace coverage will conclude Dec. 15.
Date: November 27, 2018
Source: The Daily Tribune News