June 3, 2014

Health insurance woes

ELIZABETHTOWN — Local health-care providers are being caught between patients and insurance companies when it comes to coverage.

“Our health centers are noticing a terrible side effect of the Affordable Healthcare Act and the insurance exchanges that have been set up to allow consumers to purchase insurance,” Elizabethtown Community Hospital Director of Community Relations Jane Hooper said.

“Essentially, consumers are on the website, they purchase insurance, and then they find out that their physician office does not accept the insurance that they just purchased.

“They see that their physician’s name is listed under the section of providers that accept that particular insurance, so they assume that’s accurate. When they call one of our hospital’s health centers for an appointment, it is discovered that the health center does not accept the insurance.”



The hospitals and health centers look like the “bad guy” for not accepting the insurance, but in reality, the insurance companies have the physicians listed without making arrangements for that doctor or facility to accept the insurance.

“I have to imagine that many doctors’ offices are experiencing the same thing,” Hooper said.

Generally, physician offices, health centers and hospitals negotiate with insurance companies to accept their policies. If those negotiations have not taken place, the insurance cannot be used there.

Unfortunately, some insurance companies have not worked with health centers or doctors, yet they have been listing them on their websites, which is confusing to consumers, Hooper said.

“You really need to have someone help you through the business side,” she said.



ECH has established a financial-adviser position, held by Joy Armstrong, who will help people sort through what is covered and come up with a plan. Other health facilities may have a similar option to assist patients.

Primary Care Practice Manager Robin Dunning works at ECH’s outlying clinics and has had to deal with patients who thought they would be covered.

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