A news story on Wednesday in The Durango Herald captured the plight of a Durango family, the Hunters, snagged between health insurer Anthem Blue Cross Blue Shield and CommonSpirit Health, owner of Mercy Hospital, as these giants in the health care world remained unable to reach contract terms by press time.
Anthem removed CommonSpirit from its network on Wednesday.
Ollie Hunter, 11, needs access to Mercy for treatment of myasthenia gravis, a rare autoimmune neuromuscular disease, as well as a secondary unspecified autoimmune disease. His story is one of many patients whose lives will be upturned if they must seek care elsewhere.
Statewide, more than 40,000 patients will be impacted. But in the Southwest, we are particularly vulnerable with limited – or no – providers.
Our U.S. health care system is continually dogged by the rising costs of services, financial challenges for providers, the shortage of professionals in our pricey rural area and more.
Good luck if you need in-network, local physicians or advanced practice providers.
Anthem has accused CommonSpirit of seeking prohibitively expensive reimbursement rates, which customers would ultimately pay. The hospital system has pushed back, arguing that its ask is fair, reasonable and absolutely necessary.
Despite the first-place ranking for the U.S. as having the largest economy in the world arranged by GDP, beating out China, Germany and Japan, when it comes to health care costs and access, we’re losers.
Middle-earners don’t have a government safety net and can’t rely on a health care business model that thrives without passing on astronomical costs to consumers. Health insurance is required yet the entire system has so many cracks, it seems fragile enough to shatter at any moment.
Meanwhile, many of us, including federal, county and Fort Lewis College employees, with more than 1,000 Anthem members in its health plan, are paying premiums without access to local, in-network doctors.
Besides locals, criteria for those moving to mountain towns tend to include a hospital. Remote workers, pandemic re-settlers, retired baby boomers and medical professionals, too, count on reasonable health care.
A given would be a reputable hospital that accepts common insurance.
The state Attorney General’s office can’t influence either. The impasse doesn’t meet criteria for an antitrust issue, as it’s not restricting competition.
Also reported on Wednesday, the Colorado Division of Insurance is monitoring the situation, according to spokesman Vince Plymell. He encouraged patients to proceed with caution and ensure that care is covered at a reasonable rate before pursuing nonemergency treatment.
Yes, we figured this to be the case.
The thing is, it’s not uncommon to wait many weeks or months for appointments to receive the nonemergency care we need. Now we have to find doctors out of town and start the process all over again?
As a country, what will it take to get it right on affordable health care? Each White House administration in recent memory has made steps forward – then backward. We’ll see to what degree this impacts elections.
But here we are now, waiting on the second-largest health insurance company and third-largest hospital system to come to a good-faith agreement.
Before this happens, though, try to prevent getting sick or injured.
Anthem spokeswoman Emily Snooks told the Herald that the organization informed members with “serious medical conditions” that in-network care would be covered at CommonSpirit facilities automatically through July 30.
We’re reading this to mean Ollie, the boy who visits Mercy often, will receive necessary treatments without undue hassle. At least, for now.
