While some clinics have expressed frustrations with Bright Health, consumers feel mostly satisfied with coverage | SummitDaily.com

While some clinics have expressed frustrations with Bright Health, consumers feel mostly satisfied with coverage

Peak Health hosting a closed forum on Monday, Nov. 15, for Bright Health representatives, clinics to iron out claims payment problems

Right at the beginning of health insurance enrollment season last week, a handful of local independent providers expressed frustrations with Bright Health, the selected carrier of Peak Health Alliance. Peak Health is a local nonprofit health insurance purchasing alliance that was founded in Summit County to negotiate lower insurance rates for Coloradans in rural areas.

Next year will be its third year with Bright Health as its carrier, and some clinics aren’t happy with how Bright Health has handled claim payments.

The Summit Community Care Clinic, Ebert Family Clinic and Swan Mountain Women’s Center all said they’ve had trouble getting Bright Health to pay outstanding claims. Dr. Andrew Catron, co-owner of Swan Mountain, has gone so far as to say that his clinic plans to withdraw and no longer accept Bright Health insurance plans if these claims are not paid.

If providers start to withdraw from working with Bright Health, that poses an issue for members who rely on the insurance carrier to connect them with local health care and limits the number of options members have.

Since the news broke, Peak Health Alliance CEO Claire Brockbank said her team has worked to restore the three-way partnership between Bright Health, providers and members. One of these strategies is hosting a closed meeting on Monday, Nov. 15, where providers have the chance to bring their concerns to Bright Health Colorado Market President Curt Howell and his team.

“At the meeting Monday night, there will be lots of discussion about the solutions that we have been negotiating with Bright to offer to our providers, and I’m pretty excited about those,” Brockbank said. “I don’t want to speak out of turn about those, but there is a lot of work underway to keep making progress on getting those providers paid.”

While providers are largely the ones expressing frustrations, most consumers covered under a Bright Health plan don’t seem to have any major complaints. A records request from the Colorado Division of Insurance related to the carrier’s service in Summit County for the past 18 months only turned up five closed complaints, all of which were from consumers. Peak Health has 7,000 Bright Health members, half of which are located in Summit, Lake and Grand counties.

Of the five complaints, two were in regard to reenrollment. Both complaints stated that the individual received a letter stating that they didn’t have to take further action if they wanted to keep their plan besides ensuring that their premiums were paid for. After Jan. 1 the following year, the people learned they were no longer covered when they tried to access medical care.

A third complaint said they paid their premiums, but that coverage was still being denied.

Each filed a formal complaint with the division when they weren’t able to resolve the issue after multiple attempts. Eventually, all three individuals’ coverage was restored.

One of the other complaints filed had to do with which providers were in Bright Health’s network. According to the file, the individual had selected Bright Health based on whether or not an Aurora-based clinic accepted their insurance. According to the resolution, Bright Health had incorrectly listed the clinic on their website.

The last complaint had to do with solicitation of contact information, which was ultimately deemed irrelevant and that Bright Health had not disclosed personal contact information.

Vincent Plymell, assistant commissioner for Colorado Division of Insurance, said that his department could not provide any documents related to open complaints. Plymell said there are currently two outstanding complaints from Summit County consumers against Bright Health, but he could not confirm the number of outstanding complaints from providers before publication deadline.

Brockbank said she’s well aware of some providers’ satisfaction with Bright Health and doesn’t doubt that there’d be some outstanding complaints from local clinics. But as for consumers, she said there’s no issue.

“We have not had a strong indication of consumer concerns,” Brockbank said. “I’ve been in health care for 35 years and haven’t ever found a health plan that does it perfectly. Wouldn’t that be nice? One of the things we have talked about often amongst ourselves as staff is that it does feel like for the most part, the members have been well taken care of by Bright and that Bright has been fairly accountable to its errors.”

Summit Cove resident Tom Thatcher is insured by Bright Health. Thatcher and his wife, Lisa, both own a summer camp in Maine and Thatcher works at Breckenridge Ski Resort for the rest of the year. Because of their work, Thatcher said it was more cost-effective to enroll in a health insurance plan on Colorado’s marketplace, Connect for Colorado.

He said the first plan his family enrolled in was not suited for their needs, even though he had reached out for help when selecting a plan.

“We’ve got two boys — 2 1/2 and 5 — and it didn’t cover any of their wellness visits,” he said. “Our younger one … fell over and cut his forehead on a flower pot. It didn’t cover that. Why was I advised to spend this much for this plan that didn’t fit our needs? I was a little disappointed with that.”

After learning about Bright Health’s plan, Thatcher said it made much more sense for his family since it is the same cost with a zero-dollar deductible. He plans to keep the plan going into 2022.

However, one area of concern he does have is what’s happening with local providers.

“What if our pediatrician decides that they’ve had enough of trying to get claims paid by Bright Health and then decide to drop Bright Health?” Thatcher said.

While a valid concern, some members will likely keep their Bright Health plans due to savings. Bright Health’s website not only touts a zero-dollar deductible, but it also boasts at least one zero-dollar primary care visit, over 50 prescriptions and over-the-counter medicines available at no cost and at least one zero-dollar specialist visit. Members even have the chance to earn up to $500 per year for taking healthy actions.

The cost of its plans are also significantly lower than other available plans. 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. Under a comparable plan with Anthem Blue Cross Blue Shield, the most popular carrier in Summit County after Bright Health, members could pay an additional $1,732 per year if they switched.

Friday Health is the next cheapest carrier after Bright Health. Members could pay an additional $1,160 per year under its comparable midrange plan to Bright Health’s.

Bright Health did not respond to a request for comment before deadline.

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