When John Hudson's wife lost her job as a medical records specialist in December, he knew they needed new health insurance policies.
Affordable Care Act forum
Roper Hospital is hosting a community forum about Medicaid expansion and the Affordable Care Act at 5:30 p.m. Wednesday in the hospital's Irene Dixon Auditorium. The event is free.
Lucky for the Kingstree couple, HealthCare.gov was up and running smoothly by then.
Pick a health insurance plan
Shop for a private insurance plan on the federal government's health insurance marketplace online, HealthCare.gov, by phone, 1-800-318-2596, or by calling a local insurance agent. The S.C. Department of Insurance warns residents that they should not pay anyone for enrollment help, and should disclose their personal information, including social security numbers, only to someone they trust.
The deadline to sign up for insurance through the federal marketplace is March 31.
For more on the Affordable Care Act, go to postand courier.com/obamacare.
They picked a Consumer's Choice Health Plan for $1,200 a month - one of four health insurance companies selling plans to South Carolina residents on the federal marketplace. The Hudsons' income qualified them for a large tax subsidy, which lowered the cost of their new coverage to $200 a month.
A Q&A on the March 31 deadline for the Affordable Care Act. In Business
"It's a real good deal on the surface," said John Hudson, 58, a pastor.
But then, his experience with Consumer's Choice Health Plan turned south.
"They sent us a package in the mail - a thick, brown envelope," he said. "We had to choose a medical doctor and so we started doing that."
But Hudson couldn't find a primary care doctor within 45 miles of Kingstree that would accept the new insurance, despite the fact that the company lists several local in-network providers on its website. In fact, most providers he spoke to had never heard of Consumer's Choice Health Plan before.
"All the doctors we called were not aware that they were even part of the provider list," he said.
Hudson contacted the S.C. Department of Insurance for help and was told to call customer service at HealthCare.gov. The federal government told him to file a grievance with the state. "They couldn't figure out what was going on," he said.
S.C. Insurance Department Director Ray Farmer said Hudson's story isn't surprising.
"The networks on the exchange are extremely tight, narrow choices," Farmer said. "It's just a matter of time before we hear all kinds of scenarios that no one has thought of yet."
Narrower provider networks, while unpopular with customers and some conservative politicians, are a tool that insurance companies are increasingly using to control costs. The Affordable Care Act doesn't allow insurers to deny coverage to customers with pre-existing conditions, so limiting provider choices - picking and choosing which doctors offer the best outcomes for the best value - is becoming more common.
"The term that should be used is high-value network. You don't narrow the network just because, you narrow the network to high-value providers," said Tony Keck, director of the S.C. Department of Health and Human Services, who favors the policy.
But these networks are intended to be narrower, not non-existent, he said, and consumers need accurate information to make informed choices.
Adrian Grimes, a spokeswoman for Consumer's Choice Health Plan, said the new insurance cooperative, established by a multi-million-dollar federal grant under the Affordable Care Act, addressed this issue with another new beneficiary earlier this year.
In January, Grimes said an Aiken woman signed up for a Consumer's Choice policy because a specific doctor was listed as an in-network provider on the website. But that doctor actually wasn't part of the Consumer's Choice network and neither were other providers who had been mistakenly labeled in-network.
"There were providers that were listed that should not have been listed. We had to clean all the data," Grimes said. "Unfortunately, we had some bad press from it."
Grimes said she had not heard of Hudson's case and said providers in the Kingstree area may not be aware they are part of the Consumer's Choice network because front office staff may not know about the new company.
"The providers aren't used to us," she said. "They're used to BlueCross."
Grimes said she was not aware of any problems reported in Kingstree or the Lowcountry market.
But it has been a struggle, she conceded, because the provider networks for plans offered on the federal insurance marketplace are smaller than networks traditionally associated with employer-based plans, leaving customers with fewer choices than they may be accustomed to.
"They call them more exclusive, or skinny networks, but I do know we have one of the best of all the plans across the state," she said.
Late Friday, the federal government outlined new guidelines for 2015 health insurance plans that will require policies offered on HealthCare.gov to include at least 30 percent of "essential community providers" in their networks next year.
Hudson said he recently filed a complaint with the Insurance Department and is switching to a Blue Choice plan. "Within 30 minutes, we found doctors that would take it," he said.
While BlueCross BlueShield of South Carolina dominates the private insurance market in this state, Grimes estimates that Consumer's Choice Health Plan sold about 50 percent of all marketplace plans purchased in South Carolina since enrollment opened Oct. 1.
BlueCross BlueShield of South Carolina, Blue Choice and Coventry One, which are also selling plans for South Carolina residents on the marketplace, would not release any enrollment data.
The Insurance Department said this week about 37,000 residents signed up for a marketplace plan and paid their first month's premium between Oct. 1 and Feb. 28.
Open enrollment through HealthCare.gov closes on March 31.
Reach Lauren Sausser at 937-5598.
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