As Bright HealthCare leaves Colorado, 820 Grand County residents must find a new insurance provider
Editor’s note: This story has been updated with correct information on insurance options for county employees.
In Colorado’s rural areas, which face the highest health insurance premiums in the state, health care is sometimes perceived as a privilege for those who can afford it. Nonprofits such as Peak Health Alliance have expanded affordable coverage to many community members. More recently, Peak Health Alliance has focused their affordable insurance offerings through their chosen carrier Bright HealthCare — until this year brought that health plan to a halt.
On Tuesday, Oct. 11, Bright Health announced it was pulling out of Colorado and eight other states, explaining the health insurance provider would no longer offer individual and group plans to consumers anywhere in the state.
“My first reaction was, frankly, surprise,” said Ann Ladd, CEO of Peak Health in an interview with the Summit Daily News. The nonprofit health insurance-purchasing alliance was founded in Summit County to negotiate lower insurance rates for Coloradans in eight Western Slope counties, including Grand.
Ladd said the alliance was fully focused on submitting comments for the rates Bright Health had proposed earlier this summer as well as preparing for the open enrollment period that allows consumers to choose their plans for the next year when Bright Health made its announcement.
Over 1,200 individuals in Grand County are insured by a Bright Health plan through Peak Health. Another 6,400 across the High Country and roughly 55,000 in Colorado are also insured through Peak Health.
All of them will be covered by Bright Health through the year’s end. But they will need to choose a new health insurance plan through the Connect for Health Colorado health insurance marketplace during the open enrollment period, which started Nov. 1.
Since coverage through Bright Health ends on Jan. 1, residents must find a new plan by the Dec. 15 deadline or risk losing their insurance.
Ladd said 820 Grand County residents will lose their Peak Health plan in January. There is a silver lining for individuals employed by Grand County, though, Ladd added. Coverage will continue for employees who use Peak Health through a third-party administrator called Employee Benefit Management Services.
“So if you work for the county, like the sheriff … coverage will continue,” Ladd said.
Ladd said that roughly 400 Grand County individuals receive their insurance through Employee Benefit Management Services, either as a county employee or as a family member of an employee.
Local providers saw the breakup coming
Though Ladd was shocked by the news Tuesday morning, others were braced for Bright Health’s announcement.
Bright Health began as a startup in Colorado in 2017 and partnered with Peak in 2020. Their rates were astonishingly low; High Country residents received health insurance plans that were, on average, 41% percent lower than what they’d been paying in 2019.
The promise of affordable health care crumbled when Bright Health began to avoid paying claims or flat out denying them. After an investigation by Colorado’s Department of Insurance, the company was fined $1 million. Bright Health’s reputation, and finances, took a nose-dive.
“There had been a decent amount of speculation about whether or not they were going to stay in the state of Colorado after they split ways with the (Central Rockies Physician Practice Associates),” said Dr. Theresa Clark, psychiatrist and owner of Ten Mile Health & Wellness in Dillon.
The Central Rockies Associates is made up of 120 providers, mostly from Summit and Eagle counties, which work together to negotiate with insurance companies like Bright Health. Dr. Andrew Catron, president of the group, said they received a notice from Bright Health on Sept. 29 stating that the carrier was terminating its contract on Dec. 31.
This raised an alarm for many local providers, since it essentially meant that all 120 could no longer accept Bright Health insurance. The move raised questions about the carrier’s presence in Colorado and if it would continue to operate in the state.
Catron said the group reached out to both Peak Health and Bright Health at the time, and that both confirmed the carrier intended to continue serving Colorado. However, less than two weeks after the carrier cut ties with the group, it announced it was stepping away from Colorado.
What does this mean for the High Country?
Bright Health was planning to raise its 2023 rates by 21% before deciding to withdraw from Colorado, but the assumption was that it would still offer the most affordable options for those living in rural mountain areas like Grand County, at an average of 10% to 18% lower than other carriers.
Bright Health’s departure doesn’t just impact the wallets of individuals. It also impacts access to care.
Clark pointed out that she’s one of few psychiatrists based in the rural mountain region. She said that about 30% to 40% of her patients are currently covered by Bright Health insurance and that many chose it for affordability. Many have significant health conditions that require frequent care. Clark said most other plans available on Colorado’s marketplace have high deductibles and regional doctors and physicians are frequently out of network. Without Bright Health plans, Clark said some of her patients will now have to pay higher premiums and travel longer distances for the same care they are receiving today.
Ladd said the nonprofit had already been looking for an alternate carrier to partner with in the last few months but that nothing can, or will, come to fruition for 2023. This means that next year, Peak Health will not be offering a sponsored health insurance product.
In an email sent to Peak Health members on the evening of Tuesday, Oct. 11, Ladd wrote “Bright did not always meet our expectations for customer service,” but added that “while circumstances outside of our control mean we will not be sponsoring insurance plans in 2023, we are committed to finding a new, reputable carrier partner for 2024.”
For the 820 local residents who are losing their plans in 2023, they must choose between two carriers, Rocky Mountain Health Plans and Anthem Blue Cross Blue Shield. Residents can hold out hope Peak Health will come back with more options in the years to come. As for how successful Peak Health will be in negotiating with a new carrier, Clark said that remains to be seen.
“Concerns about them making the effort? None,” Clark said. “I firmly believe Peak Health will make every effort possible to do what they can, but it ultimately depends on whether or not insurance companies are willing to try to care about more than just their total bottom line.”
Grand County Rural Health Network offers support
For Grand residents unsure of their future insurance options, Jenn Fanning, executive director of Grand County Rural Health Network, says their nonprofit can help.
“I would say, first and foremost, people who are insured by Bright Health can and should use their insurance through the end of the year,” said Fanning. “They didn’t lose it this year, that begins effective Jan. 1. So they have a moment to get through this.”
Fanning cautions that there are pirate insurance websites set on scamming people, so she says people should make sure to visit the Connect for Health marketplace directly at ConnectForHealthCO.com.
Those who are unable to make the Dec. 15 enrollment deadline still have a last resort.
“If people are unable to get insurance Jan. 1, because they lost their insurance, they’re automatically eligible for a special enrollment time frame,” said Fanning. “So (they have) a little bit more time, but they will be uninsured. It would be no different than if they had insurance through an employer and then transitioned jobs and lost their insurance, so there’s special enrollment.”
This special extension lasts 60 days from Dec. 31, but Fanning says she doesn’t recommend this route. If a person chooses insurance between Dec. 15 and Jan. 15, 2023, they won’t receive insurance until Feb. 1 at the earliest.
“That means they will be uninsured during one of the higher times when people get the most sick, the holidays,” she said. “There’s flu season, plus injuries are usually a little higher during the holidays, (because of) icy roads, skiing, just the activities that we do.”
Once anyone is ready to sign up for health insurance, they can contact Rural Health to help navigate what can be a confusing system. In a world of deductibles, co-pays and premiums, some people may end up paying more than they need. A 2021 survey of 2,000 Americans by Bend Financial, showed respondents scored an average grade of D on an insurance knowledge test. On average, respondents said they estimate they waste about $111 a month because they don’t understand their plan.
“If it’s too confusing, (Grand County residents) can work with one of our two health coverage guides if they want more education and assistance enrolling in the health insurance marketplace,” explained Fanning. “That’s their sole job, to help people enroll. … That could be a really valuable resource for folks.”
This service is free and residents can receive in-person health coverage assistance at Grand County libraries, community spaces and the Rural Health office in Hot Sulphur Springs. They offer also offer virtual appointments for who can’t make it in-person.
“We’re also encouraging every single person … to go on and shop on (the marketplace),” Fanning said. “There are a lot of health insurance plans and designs that have changed completely or are brand new this year. Even if they have insurance, (they can) find maybe a more comprehensive option or if there’s something that works better for them at a better price. Even if you decide, ‘nope, I’m good,’ you still made an educated choice.”
Fanning added that people who already have a health insurance broker can still reach out for assistance.
In addition to health care marketplace guidance, Rural Health offers financial assistance for individuals who aren’t fully covered.
“We have stop gap resources, but it’s not insurance,” she said. “We have our ACHES and PAINS program. They are vouchers for people who are uninsured and qualify financially to see local providers.”
Residents can receive vouchers for medical care for illnesses or emergencies, children’s wellness exams, dental care for their children or if they’re pregnant, and mental health visits.
Residents can be covered by basic insurance and still receive vouchers. For example, a person may be covered by medical insurance but not have insurance for mental health, or they could have medical but not dental insurance. If they are uninsured for the scope of work they need, they can receive a voucher. People can also receive multiple vouchers; for example, if they have several children who need dental appointments.
“We provide vouchers for families. Our mental health vouchers go up to at least six visits at the minimum,” Fanning said. “It’s usually more than that, since the need is usually high.”
For medical and dental, vouchers are usually available for three visits per person per scope, but “that depends entirely on the individual’s needs and what that looks like,” Fanning added.
Even though Grand County residents will lose their Bright Health insurance in 2023, Grand County Rural Health Network provides a safety net in a variety of ways. If you need assistance signing up for the best plan or are facing a medical or mental health care need you can’t afford, reach out to Rural Health at 970-725-3477 or visit their website at GCRuralHealth.org.
This article contains original reporting from the Summit Daily News.
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