Bright Health promises frustrated medical clinics it will resolve outstanding claims

Bright Health Colorado Market President Curt Howell expects to see changes take effect in 90 days

Summit Community Care Clinic's Chief Executive Officer Helen Royal discusses mental health challenges the county faces on Friday, Sept. 3. Royal said the Summit Community Care Clinic is experiencing issues with getting claim payments resolved from Bright Health, the selected carrier of the Peak Health Alliance.
Ashley Low/For Summit Daily News

On Monday, Nov. 15, Bright Health held a closed, in-person meeting for providers who are frustrated with its services, specifically as it pertains to unpaid claims. What seemed to be a meeting full of pent-up frustration ended in hopeful, albeit cautious, optimism that there is a plan for remedying the situation.

At the beginning of this year’s health insurance enrollment season, independent local medical clinics began coming forward about the severity of Bright Health’s handling of unpaid claim payments. Bright Health is the selected carrier of Peak Health Alliance, a local nonprofit health insurance purchasing alliance that was founded in Summit County and negotiates lower insurance rates for Coloradans in rural areas.

As individuals begin shopping and enrolling in health insurance plans — the cheapest of which is offered under Peak Health — some consumers are concerned that their health providers might sever their relationship with Bright, a move that Dr. Andrew Catron, co-owner of Swan Mountain Women’s Center in Breckenridge, is possibly exploring.

In an effort to restore these working relationships, representatives from Peak Health asked Bright Health Colorado Market President Curt Howell to visit Summit County and host a forum where providers could air their grievances, and he and his team could respond with meaningful steps forward.

Prior to the meeting, which was held at the Summit County Community & Senior Center, Claire Brockbank, CEO of Peak Health Alliance, said she was hopeful that this forum would provide a critical step forward in bridging the gap between providers and Bright.

“I would anticipate that it will be a good, productive work session,” Brockbank said. “… The goal is that at the end of the evening providers have some direction as to how they’re going to work through these issues with Bright.”

While the meeting was closed to the public, both Catron and Theresa Clark, psychiatrist and owner of Ten Mile Health & Wellness in Dillon, said they felt like the solution presented during the meeting was more than they expected. Catron said that during the meeting, Howell remained professional and calm, apologized on behalf of the company’s handling of claim payments and said that he’s working with a team to fix it.

“They at least claimed they are putting an independent third party in to monitor the claims, specifically for Peak Health Alliance, and that we should have a contact person to at least assist with that within the next few weeks,” Clark said. “So that, to me, is more promising than anything else I’ve heard so far. Whether or not the issues actually are addressed in a timely manner is a different thing, but this was more promising than I actually anticipated it would be.”

The idea is that this third party will help solve some of the issues related to Bright Health’s outstanding claims and that doing so will speed up how quickly these are processed. It is unclear whether this third party was the result of the Colorado Division of Insurance’s involvement with these complaints or if Bright Health took it on themselves, but some sort of collaboration has launched in the last five business days.

Part of this collaboration includes a team that is devoted to resolving claims related to Peak Health Alliance, which includes providers like Clark and Catron.

While this is a step in the right direction, Catron and Clark said they had some remaining worries. Catron said Howell couldn’t commit to resolving some of these issues within a 30-day time frame. Clark said she was frustrated that Howell acknowledged his team was working with outstanding claims, even though this work wasn’t being done to a satisfactory level.

“The one thing I was very disappointed in was Curt (Howell) repeatedly said they were working on the backlog of claims and have been decreasing their backlog of claims for months, yet even new claims being submitted have still not been paid,” Clark said. “So not only have we not been paid for the backlogged claims, the new claims we have submitted within the past 30 days or within the past 60 days are still encountering the same issues and have zero change, and the backlogged claims are being paid inappropriately.”

In addition, Catron said Howell promised contracts and provider information would also be updated. Clark said Howell told attendees that he hopes for “massive progress” within the next 90 days, but to her and Catron, this seemed like too long of a timeline.

“We have to see significant progress and resolution of their claims payment issues in a timely manner, within the next 30 to 60 days, for us to even consider staying with Bright Health,” Catron said.

Peak Health spokesperson David Rossi said there were 18 registered attendees for the meeting, including 13 individuals representing eight separate Summit County clinics. Representatives with the Ebert Family Clinic and Summit Community Care Clinic both said prior to the meeting that even though they’re experiencing the same issues, they do not plan to drop Bright Health.

Clark said the same. Because she’s one of few psychiatrists based in the county, she said she doesn’t have plans to break ties with the insurance carrier. Even so, she said she’s seeing the toll these issues are taking on patients firsthand.

“To come get your mental health help and be told, ‘No, your insurance doesn’t cover this, you’re responsible for the whole bill’ … (is) a big deal to my patients.” Clark said. “That’s a really, really big deal and legitimately has an effect on their mental health.”

Clark said a little over one-third of her patients are covered by Bright Health, and every single one of those patients has had an error related to at least one claim this year.

Catron is also experiencing massive issues. He said he currently has nearly $100,000 outstanding in Bright Health claims, 58% of which are over 120 days old.

To resolve some of these issues, Clark said she has a billing assistant whose role is to work with Bright Health to get these claims paid. Even that has seemed to be fruitless, even though they’re contacting the agency every two weeks with ongoing issues. Clark said her billing assistant spends about 50% of her time communicating with Bright Health.

“We hear over and over that ‘this has been reprocessed,’ and ‘that’s been dealt with,’ and ‘oh, just give us a minute,'” Clark said. “Three months later this stuff has not been processed and has not been dealt with. Things are being sent to old addresses or my physical address.”

Only time will tell if the solutions presented at Monday night’s meeting will have any lasting change.

“As part of the discussion, Bright HealthCare and Peak Health Alliance shared how we are working to improve providers’ experiences, including investments we are making in technology and operations,” Lauren Robb, a Bright Health spokesperson, wrote in an email. “With plans already in motion, we expect to make meaningful progress over the coming weeks and months.”

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