As of Jan. 1, St. Anthony Summit Medical Center began contracting with new exchange plans under Anthem health plans.
Connect for Health Colorado, the new insurance marketplace known as “the exchange,” was established under the Affordable Care Act for individuals and businesses to purchase health plans.
Anthem Blue Cross and Blue Shield, and its subsidiary HMO Colorado, developed the Pathway network, which includes new individual and small-group health benefit plans to be sold on the exchange.
The decision to add St. Anthony Summit to Anthem’s Pathway network was made “to be as responsive as possible to members in the Summit County community,” said Colorado Anthem Blue Cross and Blue Shield public relations director Joyzelle Davis.
Outside of the Front Range, the Pathway network isn’t any different than Anthem’s previously existing provider network, Davis said. Anthem created the Pathway network specifically for the Connect for Health Colorado exchange.
Sharon Burnette, group marketing director for the Centura Health area that includes Summit County, said while hospital officials would love to accept insurance from every carrier available in the area, it’s often not their decision.
“It’s really not in our power to choose the plans; it’s up to the insurance companies for the most part,” she said. “Anthem decided what products we were going to have to offer.”
There are four carriers in Summit County offering individual and family plans through Connect for Health Colorado: Access Health Colorado, Anthem Blue Cross and Blue Shield/HMO Colorado, Colorado HealthOP and Rocky Mountain Health Plans.
Currently, St. Anthony Summit’s website lists Rocky Mountain Health Plan, Anthem HMO Colorado and Anthem HMO Colorado Point of Service as the insurance plans it accepts.
“We are thrilled to be in the (Anthem) plan,” Burnette said. “Certain markets have different products available, but we hope that we will eventually be in any insurance products that people in our community have, so they have access to us for care.”
Anthem’s Pathway HMO offers a $1,500 deductible, but preventative care and routine doctor visits are not subject to the deductible. Anthem’s Pathway network is a statewide network, aligned with specific hospitals on the Front Range, that now includes St. Anthony Summit.
‘a new thing’
“The whole exchange is a new thing,” Burnette said. “It’s a new world we’re living in, and we don’t yet know all of the rules with these products.”
Health insurance prices depend on location, age, number of people covered by a plan, and whether the person uses tobacco products. Summit County is in Region 11 in Colorado, which has some of the most expensive rates in the state.
Burnette said because St. Anthony just started accepting the Anthem insurance, there will most likely be a few kinks in the system to be worked out.
“If a bill is rejected, we look into why that happened and go through the specifics so everyone knows the process,” she said. “There’s certainly some lag time when we add a new insurance. We want to be in every plan, to serve all potential patients.”