Park County residents frustrated after Anthem plan changes leave them without access to Summit County doctors
For the first time in 29 years, Fairplay resident Anne Slubowski isn’t sure who her doctor is.
On Jan. 1, Anthem Blue Cross Blue Shield transitioned Park County customers like Slubowski from the company’s typical individual insurance plan to the Pathway Essentials plan. The major difference with the new plan? Its network doesn’t include Summit County providers.
For most people across the state, not being able to access Summit County doctors isn’t a huge deal. However, for Park County residents like Slubowski and Nancy McDowell, who lives in Alma, the new plan is forcing them to start from scratch when it comes to health care coverage.
Both women have been using Summit County doctors for decades, as Park County’s only provider who accepts insurance is Dr. Katherine Fitting at South Park Health Care in Fairplay.
The new network includes providers in Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Clear Creek, Elbert, Gilpin, Jefferson and Park counties, according to the Anthem website. Summit County residents who use individual insurance have access to the company’s Mountain Enhanced plan, which offers providers in Summit.
The Pathway Essentials plan leaves the two women with a decision between going to Fitting for care or finding a doctor in Denver.
Slubowski said she initially heard about the change in her coverage from McDowell, not Anthem, after enrollment had closed.
“I was at work one day, and Nancy was like, ‘Did you know that Park County residents after the first of the year can no longer use Anthem over in Breckenridge?'” Slubowski said. “I never heard anything from my insurance company.”
The change only applies to those who use individual insurance, meaning they don’t receive insurance through their employer.
For Park County residents who opt into individual plans, the only coverage option is Anthem. McDowell said her employer plan costs three times as much as the individual plans.
“I could use Summit County (providers), but it would cost a lot more than my mortgage costs,” she said.
Tony Felts, the Colorado spokesperson for Anthem, said the reason for the change is to offer lower premiums.
“It is an option for consumers who are comfortable with a slightly smaller network of health care providers than other Anthem plans,” Felts wrote in an email. “Pathway Essentials can save consumers an average of 20% on monthly medical premiums compared to their 2020 Anthem individual plans.”
The Pathway Essentials plan also was approved by the Colorado Division of Insurance, which has set requirements that look at the number of providers for a certain area.
“As part of its review of the 2021 plans and premiums, the Division of Insurance reviewed Anthem’s 2021 network of health care providers (doctors, hospitals, etc.), and we verified that Anthem still met the requirements for maintaining an adequate system of in-network providers for its members in Park County,” division spokesperson Vincent Plymell wrote in an email.
Although it met official requirements, both McDowell and Slubowski feel the change in plans has disrupted their lives. McDowell said that while the South Park Health Care office is a valid option, there’s not much in the way of specialty care.
“If you need to get referred for a specialty, or whatever, it feels like you’d be better off making those connections down in Denver,” she said. “The level of care is wonderful, but it takes an hour and 30 minutes at least to get down there.”
McDowell and Slubowski are also concerned about the lack of communication throughout the process. The two automatically re-enrolled in Anthem’s individual plan option, not knowing that it would mean losing access to Summit County providers in 2021.
“How many people don’t even know that this happened?” Slubowski said. “There was never anything put out there. Then I started talking to other doctors … and their jaws about hit the ground when I told them.”
McDowell said she didn’t hear about the change from the insurance company, either. Instead, an insurance navigator, who is also a friend, informed her of the new plan.
Although both McDowell and Slubowski said they didn’t receive any direct messaging from Anthem, Felts said the insurance company “sent a notice of the change to Anthem consumers at the end of September.”
Ultimately, the change makes McDowell and Slubowski feel less connected to the Summit County community in which they work and spend their time.
“My son is a senior at Snowy Peaks,” McDowell said. “His school is less than 5 miles from a major medical clinic that we now cannot use.”
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