Out of Business Cooperative

[leonard]

Some state health insurance coops have gone out of business. i know what happens to an insurance company's clients in this type of situation, but what happens to the unpaid claims?

 

[Yagents]

They remain unpaid...........................

Who loses? The providers

Who chases the patient down for payment? The providers

 

[jbage007]

They remain unpaid........................... Who loses? The providers Who chases the patient down for payment? The providers

who is responsible for claims?

THE INSURED

So guess who an unpaid provider is going to go after?

THEIR PATIENT

 

[AllenChicago]

Providers that accepted Co-Op Insurance in 2015 are getting squeamish about doing so again in 2016. Some are bailing, but the Co-Op "Provider Finder" lookup database isn't being updated to reflect it. We're now calling the Provider before enrolling, just to make sure they are accepting the Co-op for 2016.

But I'm not sure how the contract between Provider and Insurer works, as far as how obligatory that agreement is. It might be as weak as the commission contract between insurer and agent.

 

[RayNY]

Providers that accepted Co-Op Insurance in 2015 are getting squeamish about doing so again in 2016. Some are bailing, but the Co-Op "Provider Finder" lookup database isn't being updated to reflect it. We're now calling the Provider before enrolling, just to make sure they are accepting the Co-op for 2016.

But I'm not sure how the contract between Provider and Insurer works, as far as how obligatory that agreement is. It might be as weak as the commission contract between insurer and agent.

Provider contracts are generally written similarly to the broker contracts-no power, no rights, have to take whatever the carrier decides to give. Just like a broker refusing to sell a certain company, providers choose to not see patients with certain coverage.

I usually just say "you've signed the contracting for XYZ network, the carrier confirmed, are you saying you're not contracted with them?" They then confirm that they are contracted, and I say "if your contract is in force, you must accept this client, it's a violation to turn them away".

No clue if that's true at all, but it gets my clients taken care of.

 

[MBSC]

Iowa and Nebraska:

The Iowa and Nebraska Life and Health Insurance Guaranty Associations will begin paying health care providers more than $80 million in outstanding eligible claims for health care services provided to CoOportunity Health members in Iowa and Nebraska. All providers under contract with CoOportunity that offered health care services will be paid up to $500,000 per individual for claims submitted to CoOportunity.

Reference: http://businessrecord.com/Content/D...0-million-in-CoOportunity-claims/-3/248/67862

South Carolina:

Consumers' Choice is required to submit a run-off plan to the SC Department of Insurance. "This should be an orderly run-off of the company's business. Our expectation is that the company will honor its existing commitments to policyholders and health care providers as a part of winding down its operations".

How will CCHP closing affect my current insurance coverage? Current plans will continue uninterrupted through December 31, 2015. Members can continue to use their insurance through that time period and continue to submit claims for all medical expenses that occur through December 31, 2015.

What does the wind down of CCHP mean to providers? Providers will be paid for claims incurred through December 31, 2015.

Reference: 2016 Important Message | CCHPSC

New York:

A quirk of New York state law has compounded the problem. All states have so-called guaranty associations, which function as safety nets if an insurer falls into insolvency. New York is the only state where the guaranty association doesn't cover claims of health-insurance companies. But it does cover health-insurance claims if policies are sold by a life-insurance company.

 

[leonard]

Thanks. I did not know if the Guaranty Associations would be applicable.
I do think some limits are out of touch with reality. for example, the odds of someone having a health insurance claim over $500,000 I would think are much less than someone having another type claim over the following limits:

[Cash Value or Surrender Value of Annuities – $250,000]
[Cash Value or Surrender Value of Life Insurance Policies – $100,000]
[Death Benefits of Life Insurance Policies – $300,000]
[Unpaid Health Insurance Claims including Dental/Vision Claims – $500,000 for Major Medical]

 

[insuranceconceptscindy]

Nevada's co-op is not protected by the state guaranty association. The providers are basically screwed at the moment. Having said that, I was told by a rep from our co-op that the Federal Re-insurance program is supposed to help out in some way. It sounds like the closing of the co-op is being handled like a bankruptcy- broker commissions at the very bottom. I haven't been paid since July, and I don't anticipate to ever receive anything. Luckily, I had only 1 client that demanded a co-op plan. I got to say I told you so!