Missouri wants MU Healthcare and Anthem customers to know that despite the companies not seeing eye-to-eye on a new contract, patients still have health insurance.
State Department of Commerce and Insurance Director Angela Nelson told Show Me Today there is no need to panic.
“These things go on all the time. It’s just in most cases, folks are not aware. There’s not this much attention given to it. Individual doctor’s practices could lose their network status anytime of the year. This one is garnering so much attention because of the size of MU Health,” Nelson said.
The negotiation breakdown affects about 90,000 customers, including Missouri’s state workers.
She said the difference patients are likely to experience during the impasse is the out-of-pocket costs if they continue to see an MU Healthcare provider. Until the companies sign off on a new deal, MU Healthcare providers are considered “out of network” for Anthem customers.
“If they have a deductible, they may have to meet a new deductible for the out of network benefit,” Nelson said. “But the most common thing they’re going to run into are their co-payments for office visits, and those may change. You know, for instance, they may have a co-payment that’s currently $40. If they go out of network, maybe that co-payment goes up to $55.”
Nelson said there are exceptions.
“If you or a child, or if your spouse is covered under your employer plan has a chronic condition, there are provisions where you can continue to see your same provider, receive the same care that you have been provided, at the in-network benefit,” she said.
What about a specialist for a particular health condition?
“I’ve heard a lot of folks say, ‘Well, I have a specialist and they’re only at MU. Nobody else has a provider that has that particular specialty.’ Most plans also have exceptions for those type of circumstances. So for instance, if there’s not another provider in that specialty within a certain mile range, the health plans will go ahead and treat that as an in-network benefit,” said Nelson.
There are also no network restrictions for emergency medical care.
“Missouri law absolutely provides that you can be transported to the nearest facility, and you will be provided in-network coverage to screen and stabilize you. Essentially what that means is they’re going to save your life,” said Nelson. “And so, we don’t want folks, if they’re facing an emergency situation, to worry about, can I go to this hospital?”
She encourages customers to discuss their eligibility with Anthem or Missouri’s Department of Commerce and Insurance.
To confirm the status of exceptions, state employees are advised to call the family advocate listed on the back of their health insurance ID card. All other patients can call the Customer Service number on the back of their insurance card.
For more information about out-of-network care, visit insurance.mo.gov or call the DCI Consumer hotline at 800-726-7390.
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