Customers signing up for an MVP health insurance plan through the new government-run exchange might find they can't get treatment from doctors in Genesee County.
A local healthcare provider was alerted to the potential hole in coverage and he said he's confirmed it with MVP representatives.
The lack of local coverage arose after UMMC declined to sign a reimbursement agreement with MVP.
The situation affects only customers who sign up for individual plans through the exchange. People who get any type of group coverage through MVP or who get MVP health insurance directly from the company (rather than through the exchange) are not affected.
An MVP spokesman has not responded to a request for an interview.
Jeff Baldick, at Genesee Orthopedic, alerted The Batavian to the hole in coverage and said he has spoken directly with MVP about the situation and confirmed with the insurance provider that his patients who purchased insurance from MVP through the exchange will not be covered.
He said MVP told him that it is not providing coverage for any patient in Genesee County who purchased insurance through the exchange.
According to Bob Chiavetta, CFO for UMMC, the hospital was presented with a take-it-or-leave-it reimbursement plan by MVP some months ago for patients covered by insurance through the exchange.
The hospital rejected the reimbursement agreement because the health care reimbursements are significantly lower than those of other insurance providers, even lower than what MVP reimburses for group coverage and Medicaid.
So while the hospital continues -- as it alway has -- to accept patients covered by these other MVP products, it has no agreement with MVP for reimbursements of patients who purchased MVP insurance through the exchange.
"We communicated to them that those rates were not adequate," Chiavetta said. "They told us they were trying to work on their network and would get back to us, but we never heard anything back from them. We never received a letter or any written communication that we were being excluded. Then a week and a half to two weeks ago, we started hearing from patients that we were not listed as a network provider. When we heard that, we spoke with them and we're trying to work through something."
Chiavetta is hopeful an agreement can be reached soon with MVP to provide adequate reimbursements for patients who purchase MVP insurance through the exchange.
MVP is the only insurance provider, Chiavetta said, who significantly lowered reimbursements for patients coming through the exchange. All of the other insurers, he said, provide reimbursements to the hospital that are consistent with policies obtained outside the exchange.
It was Chiavetta's understanding that MVP was providing coverage on the exchange product to patients in Genesee County up to the point the patient might get referred to UMMC, but Baldick said MVP told him explicitly that no Genesee County patients would be covered because any doctor's office visit could potentially result in a referral to the local hospital.
Across the board, Chiavetta said, the Affordable Health Care Act, is leading to lower reimbursement rates for the hospital, but that won't affect the quality of care at UMMC.
He's more concerned, he said, about the higher out-of-pocket expenses some patients might encounter if they purchase health insurance through the exchange.
The lower premium plans have deductibles as high as $6,500 annually.
He said people planning to purchase health insurance through the exchange should look very closely at those plans and ensure they are adequate to meet their needs. Just because a monthly premium is as low as $200 doesn't mean it's the right plan for an individual.
"I can see where it's attractive to them," Chiavetta said. "The only thing I would say is for people who are actively looking for insurance on the exchange is be very aware of what the cost is going to be. A lot of people are gravitating toward the lower premium plans, but that's a risk. It doesn't take much of an illness to cost a lot of money.
"A product for $200 a month might work great for some, but they might be better off paying more if they picked a higher plan. You've got to take your own health care needs into account."
The hospital has three people going through training next week on how to help people navigate the exchange.
"As patients come to us who are uninsured, just as we do now, we will help them understand financial assistance, Medicaid, and we will add to that help in getting through the exchange and selecting a health care product that is out there that is appropriate for them," Chiavetta said.
Anyone with questions now are welcome to call Sue Brown, director of patient financial services, at (585) 344-5428.