Insurance commissioner watching consumer issues

Sept. 27--TUPELO -- Vulnerable rural hospitals, surprise medical bills and emerging health insurance products are among the top issues the Mississippi Insurance Department is watching.

Mississippi Insurance Commissioner Mike Chaney, along with Bob Williams, who heads the department's life and health actuarial division, briefed the attendees at the 22nd annual Health Link Managed Care Conference on Wednesday about evolving health insurance and access issues in the state.

"We try to protect the consumer," Chaney said. "That's our mission."

Chaney is particularly concerned about the financial health of rural, independent hospitals.

"They serve a community that tends to be older, sicker and more dependent on public insurance programs than their urban counterparts," Chaney said. Because of declining reimbursements and increasing costs, these hospitals are particularly vulnerable.

Five Mississippi hospitals have closed since 2010. Four hospitals, including Gilmore Memorial Hospital in Amory have filed for bankruptcy protection. Among Mississippi's 19 county-owned, independent hospitals, a state auditors report found that only five were considered in excellent or good financial health in 2016 fiscal year. The bulk of the troubled hospitals are concentrated in the Delta and Southwest Mississippi. If any of those rural hospitals close, it can be devastating for the community.

"If you lose health care, you lose economic driver in the community," Chaney said.

It also can affect network adequacy requirements for insurers, potentially disrupting coverage across the state, Chaney said.

Association plans

The insurance department also has been closely tracking regulatory developments on association health plans and short term plans. These plans are not subject to many Affordable Care Act requirements. Chaney had been particularly concerned about how the plans would be regulated. The Department of Labor guidelines released in June revised and expanded the definitions to allow more small business and self-employed individuals to potentially benefit on the association plans and similar groups.

New federal rules and orders have opened these to oversight by states. The association plans will have to include safeguards similar to large employer health plans, Chaney said.

"You will not see them in Mississippi unless they are fully funded," Chaney said. "We want to be certain claims are going to be paid."

With short term plans, it is important that consumers understand exactly what they are getting, Chaney said. These plans typically have limited if any coverage for pre-existing conditions, are not guaranteed issue and offer limited benefits and very narrow networks. However in a market where individual policies can be very difficult to purchase, they can serve a purpose, Chaney said.

Surprise medical bills

There is an increasing frustration with surprise medical bills, Chaney said. There is a state law prohibiting balance billing, where a medical provider accepts insurance assignment but bills patients above and beyond their obligations. However, federal law doesn't prohibit balance billing for self-funded health insurance plans, and there is bipartisan federal legislation in the pipeline to address the issue.

In Mississippi, air ambulance companies have been among the worst offenders, Chaney said, billing patients for tens of thousands of dollars over and above insurance payments. The insurance department has advocated successfully in about 60 cases.

Although air ambulance providers have argued they are not subject to Mississippi's laws against balance billing, Chaney said he believes a case can be made that the medical services provided on board are in fact subject to state law.

There have also been problems with patients receiving bills from out-of-network providers when they've sought care at a hospital that is in their insurance network. Emergency departments and radiology have been the biggest trouble spots.

"We're going to take a pretty hard line," Chaney said.

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