Clinic, Beacon patients on exchange plans no longer accepted in 2018

Dec. 02--GOSHEN -- Janet Froelich couldn't believe it when she got a letter saying her doctor won't accept her insurance in a few months.

The 60-year-old Goshen resident received a letter from her doctor's office Tuesday saying the providers of Elkhart Clinic LLC will no longer participate with the two remaining insurers in the state's health care exchange. The clinic will stop accepting Managed Health Service's Ambetter plans Feb. 24 and will stop accepting CareSource plans March 25, the letter states.

Froelich made some calls to see if it was true. She learned that Beacon Health System, which is not affiliated with Elkhart Clinic, will stop accepting CareSource even sooner -- Dec. 31.

She also learned that only two places within an hour's drive, the St. Joseph Regional Medical Center in South Bend and Physicians Urgent Care in Elkhart, which has a joint venture with St. Joseph Health System, would accept her insurance after spring 2018.

"I asked what do I do if I have a heart attack?" Froelich said, recalling phone conversations with CareSource staff. "She said she didn't know what to tell me," but to check back in two weeks to see if the situation had changed.

But Froelich noted that Dec. 15 is the deadline for signing up for insurance.

"Why would people pay for it if they won't take the insurance?" she asked.

'Thank God I'm healthy'

John Russo, an Ambetter customer, has to get insurance on the exchange as the self-employed owner of an RV business in Elkhart. He also got a letter from Elkhart Clinic, in addition to one from Ambetter saying his monthly premium estimate went up from $761 to $1045.

"It's really stupid, especially if you're self-employed, it's just impossible to get insurance," Russo said. He's heard similar stories from dealers in other states.

He made some inquiries of his own, including one to Sen. Joe Donnelly, whose office responded by saying the senator contacted the four insurers in Indiana's exchange. The statement says the four companies, which also included Anthem and MDwise until they pulled out this year, cited the White House's refusal to commit to making key cost sharing reduction payments as a primary factor for increasing rates or exiting the market.

Russo said he still has local options for a health care provider but isn't sure of his chances of finding a doctor who is accepting new patients.

Froelich said she's switching to a primary doctor in St. Joseph County and will have to be transported to South Bend if she needs hospitalization. She's disappointed by what she called administrative struggles between Beacon and CareSource and feels let down by the healthcare system.

"Thank God I am currently healthy," she said. "God help those that are not so fortunate and have to find transportation to get them to a physician outside of our county."

Also disappointed

Beacon said in a statement that it's also disappointed.

"Much like these customers, we are disappointed in CareSource, for not living up to their promise and contractual obligations," says the statement provided by Heidi Prescott, media relations specialist. "Beacon advised CareSource customers about this decision so they could make other arrangements prior to the open enrollment deadline Dec. 15."

The statement directs CareSource customers to call their broker or to call Beacon Health Navigators at 574-524-7586 for English or 574-524-7518 for Spanish. Customers can also go to beaconhealthsystem.org and search under "health insurance navigators" to learn about the resources available.

For HIP and Medicaid members, in most cases, a new plan will allow them to keep their current physician, according to the statement.

A message was left with CareSource seeking comment. A call was made to Elkhart Clinic's main office Friday afternoon but it was not open.

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