Independent Summit County medical clinics voice frustrations with Peak Health Alliance’s selected carrier, Bright Health
Some clinics say they have outstanding claims from many months ago, and one doctor says he either wants to be paid or will no longer accept Bright Health as a carrier
Editor’s note: This story has been updated to correct that Anthem Blue Cross Blue Shield and Bright Health are the only providers in Grand and Lake counties.
Monday, Nov. 1, marked the beginning of the health insurance enrollment season.
In October, Gov. Jared Polis’ office announced that the state’s reinsurance program will save Coloradans living on the Western Slope an average of 37% in 2022, and Peak Health Insurance’s rates are substantially lower than other premiums for next year, too.
But there are a few local medical clinics throwing a curveball by banding together to spread the word about their frustrations with Bright Health, 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.
One of these clinics reports that it has outstanding claims from months ago and that if not paid, it’ll no longer accept Bright Health as a carrier. Currently, Peak Health has 7,000 members, all of which are covered by Bright Health.
Leading the charge in spreading the word about Bright Health’s issues is Dr. Andrew Catron, co-owner of Swan Mountain Women’s Center in Breckenridge. Catron says his clinic and others in the community, such as the Ebert Family Clinic, have experienced significant issues with Bright Health over the past year. Now, during enrollment season, Catron said he wants to inform consumers about these challenges as they choose their plans.
“The facts of it are that Bright Health has had severe and persistent problems paying claims for their insured patients (and) for services that we and other providers in the community have rendered to their insured patients,” Catron said. “Those problems include, No. 1, we have claims that are over seven months old that Bright Health has not paid on behalf of their clients. Secondly, they have denied payment to their customers and told us that their customers are not their customers when in fact they are. Thirdly, they’ve paid inaccurate claims amounts, and they have not been able to provide us a rate sheet with their payment rates.”
In addition, Catron said Bright Health has denied payment for various surgical procedures, saying that these procedures were not pre-authorized when Catron says they were.
All of these problems have occurred over the past year or so, and Catron said his clinic, which is one of several experiencing issues with the insurance carrier, has tried mitigating the issue to no avail. At one point, leaders at Bright Health offered a cash advance to providers and interest on late payments, but Catron said when his staff members tried following up about this, they were told three weeks ago that the offer no longer stands.
Bright Health spokesperson Lauren Robb said the company is committed to its partnership with Peak Health Alliance and is working to mitigate some of these issues.
“We are currently working with Peak and the providers in the Peak network to address their concerns as quickly as possible,” she wrote in an email.
Catron said his clinic has reached out to Peak Health Alliance to express its frustration with Bright Health but has gotten no answers from the organization about how to move forward.
Claire Brockbank, CEO of Peak Health Alliance, said she’s heard little from providers about what has been happening but knows there are some complaints filed against the insurance carrier with the Colorado Division of Insurance. Brockbank said she thinks these issues are stemming from Bright Health’s serious growth in the past year. She said she does not believe the company is intentionally trying to find ways to avoid payment.
“I think there are issues with payment and speed of payment, 100%,” she said. “Bright has a payment system that they anticipated would have to go from servicing about 150,000 members in 2020 … to about 250,000 members in 2021. And instead, on Jan. 1, 2021, they’d gone to 500,000 members, and their system shut down.”
Though it seems Bright Health is struggling to scale its business, Brockbank said Bright Health leaders have told her they are working on playing catch-up. She said Bright Health’s management recently told her they are processing more claims than what’s coming in and are making progress with the backlog. Even still, Catron said he’s frustrated the company is planning to absorb new members this enrollment season when it’s not caught up from the last enrollment period.
“They have grown rapidly,” Catron said. “Bright Health just went public … this summer, and they rapidly grew from last year to this year and not just in Colorado. And now they are planning to continue despite their issues with claims processing. They are planning to (add additional) states and many markets next year despite their apparent inability to service claims on behalf of their customers.”
The Summit Community Care Clinic said it’s also experienced billing issues with Bright Health, but CEO Helen Royal said the clinic is on the side of patients and will not be influencing whether they should stay away from Bright Health plans.
“Yes, we are having billing problems. That is not unusual with insurance companies, frankly,” Royal said. “We have an avenue to get them resolved. Based on our billing issues, we’d never influence patients’ choice on insurance companies. That’s a personal choice for patients. … We’ve had our own billing issues, so we know how that happens. The fact (Bright Health is) willing to engage and work through problems is what we want to see, and we’re taking those avenues.”
Catron said he’s not trying to sway individuals away from Bright Health plans but rather give consumers information as they make their insurance decisions this season.
To Royal’s point, advocating against Bright Health could have a serious financial impact on the community.
Peak Health spokesperson David Rossi said premiums are based on age and whether someone is a smoker. For a 40-year-old nonsmoker, the cost of Bright Health’s midrange plan through Peak Health is about $3,221 per year or about $268 per month.
Anthem Blue Cross Blue Shield is the most popular carrier in Summit County after Bright Health, and its comparable midrange plan is about $4,953 per year or $413 per month. Members could pay an additional $1,732 per year if they switched.
Friday Health is the next cheapest carrier after Bright Health, and its comparable midrange plan to Bright Health’s is $4,381 per year or $365 per month. If members switched, they could be paying an additional $1,160 per year.
Currently, Peak Health Alliance’s Bright Health plans are available not just in Summit County but also in seven other counties, including Dolores, Grand, Lake, La Plata, Montezuma, Park and San Juan. Rossi noted that Friday Health is not available in Grand or Lake counties, meaning members have only one other choice — Anthem — if they do not enroll in a Bright Health plan.
Even though their message could seriously impact a patient’s wallet, Catron and other clinics are planning to move forward.
“While Bright Health plans may seem like a good deal because their premiums are lower than other plans, they are actually a bad deal if they don’t pay providers for their customers’ medical care and don’t have local providers on their plan because of that,” Catron wrote in a text message.
Catron noted that moving forward, he’d like to get paid for outstanding claims. In the meantime, he’s going to spread the word about what he called severe issues with Bright Health. If payment is not resolved, Catron said his clinic plans to withdraw and no longer accept Bright Health insurance plans.
Dr. Christine Ebert-Santos of Ebert Family Clinic said her clinic is not dropping Bright Health at this time because she doesn’t want to create more barriers for patients. Ebert-Santos said her small administrative staff spends many extra hours on the phone with the insurance company staff to get payment.
Though surprised by the measures Catron is taking, Brockbank said she believes all of these issues have a reasonable solution.
“I think this is a really important issue, but I also think it’s eminently solvable as long as we all stay focused,” she said. “The problem we want to solve is getting the doctors paid, the folks in Summit County continue to access affordable health insurance and see their independent providers.”
Brockbank and her team are taking steps to solve these issues by hosting Bright Health Colorado Market President Curt Howell on Nov. 15 so providers can gather and share their frustrations and collaborate on how to move forward. Peak Health also plans to host a forum for members to ask Howell questions.
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