Cathrall: Obamacare and the Summit County conundrum
December 29, 2013
Obamacare and Summit County
Obamacare is a good thing — but not for all Summit County residents. Those lucky enough to have a grandfathered health plan and those on Medicare and Medicaid are in excellent shape. But those whose employers switched into an HMO plan, and those seeking insurance on the Colorado exchange or directly from an insurance company, are at a disadvantage.
The large deductible and out-of-pocket expense may or may not be a deterrent for those who consider themselves healthy. However, the fact that St. Anthony Summit Medical Center (Summit County's only hospital) is not a provider on any of Anthem HMO policies, including the most expensive Gold plans, is a major concern. All Colorado Exchange policies and all new Anthem Colorado offerings outside the exchange are now HMO policies.
In an emergency, an ambulance, the ER and subsequent admission would be covered since under the new law ambulance service is required to deliver a patient to the nearest ER. The plans work if the ambulance/ER is considered an emergency and not just a "convenience."
However, if your hospital stay is not an emergency, all bets are off. While most Summit County primary care providers have signed up for the HMOs, their admitting privileges would likely be to St. Anthony Summit. That non-emergency stay (for whatever reason) would not be covered in our non-network hospital.
Also, if you are going to have a baby, your local hospital of choice is not in the network. Want to have your baby in Vail (so that you will be covered)? Make sure your obstetrician has admitting privileges there.
If you need tests — MRI, CT, x-ray, lab work or out-patient surgery — expect to travel to Vail as St. Anthony Summit is, once again, out of network.
Why should a Summit County resident need to use a hospital in Vail, Kremmling or Leadville when our taxes subsidized the Summit medical center? Our county contributed free land and waived and reduced fees to bring the hospital here. Now, the hospital chooses not to provide services to all who live and work here. All other hospitals in the Centura system are in the network, but St. Anthony Summit is not. A non-emergency use of its services means that you will pay 100 percent of the cost — but that cost does not even count against your deductible or your out-of-pocket.
The situations I have presented — and the potential consequences — have been checked out with representatives from both the Colorado Exchange and Anthem. Both also advise that it is the responsibility of the patient (not the doctor) to check on the network status of their provider.