Denver-area Anthem customers on Colorado exchange forced to switch doctors

Problem Solvers

DENVER (KDVR) — Laura Packard was diagnosed with stage 4 Hodgkins-Lymphoma cancer in 2017. The 44-year-old moved from Nevada to Colorado in 2019 for one reason: the state’s heath insurance exchange that provides affordable options to individuals who otherwise can’t get coverage.

“As a cancer survivor, no insurance company would cover me if they didn’t have to,” said Packard, who has been in remission since 2018.

Doctors at UCHealth have continued to treat Packard to make sure she stays cancer-free.

“I can’t go without seeing an oncologist. I’ve only been in remission for a couple of years,” said Packard, who was devastated to learn her insurance carrier that Anthem and UCHealth couldn’t reach an agreement for 2021.

“They know you and what you’ve been through and I think if you look at national rankings, it’s pretty clear where people fall. UCHealth has expertise that nobody else offers,” said Packard.

The contract dispute between Anthem insurance and UCHealth means Anthem patients in metro Denver will have to switch doctors if they want to stay in-network beginning Jan. 1, 2021.

Midnight is the deadline for Colorado residents who use the state health exchange (known as Connect for Health Colorado) to sign up for insurance coverage.

“If I lived just a few miles north in Boulder, I could keep my doctors but Anthem is refusing to offer that for people here,” said Packard.

Colorado’s Department of Insurance confirmed to the FOX31 Problem Solvers that Anthem’s in-network plan still includes UCHealth doctors and hospitals for the rest of Colorado; only metro Denver has been replaced by a plan that uses HealthOne doctors and facilities instead.

“We can’t dictate who they (Anthem) contract with, only that they have an adequate network,” said Vincent Plymell, the assistant commissioner for the Colorado Department of Insurance.

Plymell said Anthem met state requirements when it ensured its contract still included an in-network provider, such as HealthOne.

“They (Anthem) were able to bring the premiums down in the Denver area by over 20 percent and the majority of that was due to negotiated rates that had with HealthOne and that’s a big concern for us as well, is keeping  premiums down,” said Plymell.

“They claimed there would be some kind of great savings but what good it is for people like me if we save a few dollars a month in premiums and then have to pay all that to see our doctor-of-pocket?” said Packard.

The Problem Solvers have spoken to other patients besides Packard who don’t want to switch to HealthOne but can’t afford the out-of-network fees UCHealth would now require.

“If my cancer recurs and I need the kind of treatment that I can only get at UCHealth, that is hundreds of thousands of dollars and I could die without that treatment,” said Packard.

Some Anthem patients can apply for what’s called a “Continuity of Care” if they have an acute condition. But Laura Packard said she doesn’t qualify because her cancer is in remission and that option requires approval from Anthem and usually only extends care through UCHealth for 90 days.

Anthem would not tell FOX31 how many patients are affected in metro Denver by the switch to HealthOne.

However, a spokesman did offer the following statement:

“Anthem Blue Cross and Blue Shield/HMO Colorado is the only health insurer to offer benefit plans in every Colorado county, on- and off-exchange, including the counties that make up the metro Denver region. This year we introduced a new network and set of plans, available in the metro Denver area, that have virtually identical benefits but can save consumers an average of 20 percent on monthly medical premiums compared to their 2020 Anthem individual plans. The plan offers a network of more than 800 doctors and 3,000 specialists. UCHealth was invited to be a network provider in this new plan, however, they declined to participate in our effort to deliver more affordable health insurance options to consumers. UCHealth does remain in-network for all other Anthem statewide networks. Consumers are encouraged to contact their broker or Anthem with questions about the available choices.”

A spokesman for UCHealth said the hospital chain wasn’t notified until this fall that its facilities would no longer be part of Anthem’s plan for customers in metro Denver, which is why it doesn’t have an alternative plan. 

In an email, UCHealth told the Problem Solvers,

“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.

 “We are working with many patients to help them request an exception to the network change that will ensure continuity of care and allow them to continue seeing their same providers.”

A spokeswoman for HealthOne told FOX31, “In terms of services offered, those will be comparable and we are confident that any patient who was receiving services at another system and requires transition of care with Anthem, that care can be accommodated at our hospitals.”

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