The brief ban of health insurer Centene Corp. in the state of Washington in December 2017, prohibiting it from selling 2018 Obamacare plans to customers, failed to yield the desired result of increasing the coverage of doctors such as anesthesiologists. As a result, the state recently decided to impose a fine of $100,000 on Centene’s Coordinated Care unit, said Deputy Commissioner for Public Affairs at Washington’s Office of the Insurance Commissioner Steve Valandra.
Centene had made the Affordable Care Act (ACA) or Obamacare plans a vital part of its growth trajectory in a renewed strategy that came after years of selling private-sector versions of the Medicaid (the federal-state plan meant for the poor). Hence, this jolt is a major setback for Centene, as the health insurer had penetrated into markets snubbed by other players by adopting the Obamacare plans.
On the other hand, the company has said that it is working toward fixing the problem of shortage of doctor access so that everything becomes seamless. The company on its part is also disappointed for not achieving much at a rapid pace, revealed Marcela Hawn, a company spokeswoman in an email.
“We hold ourselves to high standards and we expect to have these issues corrected in very short order,” she wrote.
Centene facing allegations from customers as well
It is not only the state with which Centene is locking horns, even its customers have alleged that the company has misled them by lying about doctors covered under its health plan. It is also dealing with a lawsuit filed by its customers in Washington. However, the company has refuted all charges of providing inadequate doctor coverage to customers.
Centene CEO Michael Neidorff incorporated many of the strategies developed during its Medicaid business into the expansion of Obamacare plans. It included limiting hospitals—where members are supposed to receive care—and signing up of doctors charging lesser reimbursement rates. Although such strategies help in cutting down premiums of patients, it could also lead to a shortage of hospitals and doctors attending to patients.
Considering these hiccups, regulators in Washington had barred Centene in December 2017 from selling health insurance plans in 2018. The state lifted the ban only after the company agreed to pay a $500,000 fine and fix the shortage of doctors and hospitals for its clients.
Insurance is a key element in managing rising healthcare costs. A lot of people bank on health insurance plans to take care of their expenses in the advent of a health issue. So, when things become blurred in insurance plans and people do not get what they have been promised, it causes a lot of tumults. Insurance companies are governed by regulatory bodies so that when a health insurer errs, such restrictions do crop up for them.
For patients of mental health problems and substance use disorders, such an interruption could be overwhelming, as they are more vulnerable to further complications in the absence of proper treatment. Health insurance companies selling plans to such patients should act with more sensitivity and not try something that disrupts their continuous treatment. If that happens, such susceptible patients are left in a limbo, and their predicament worsens as a result.
Dealing with mental health problems
It is difficult living with a mental health illness. However, it is also treatable with a timely intervention in credible mental health treatment centers. If you have a loved one struggling with a mental health issue, seek immediate help from a mental treatment center in your vicinity.
Sovereign Health is a premier mental health treatment caregiver in the United States that offer evidence-based treatment to patients. Call our 24/7 helpline members to know more about our renowned mental health rehabilitation centers. Alternatively, you can also chat online with one of our experts for immediate assistance.