Insurance processing issues cause concerns for HIV programs

Jan. 09--Coventry Health Care Inc. is still processing insurance applications for coverage starting Jan. 1, and for some Missouri patients that's causing concern about access to medications and medical care.

Cale Mitchell, executive director of Spectrum Health Care in Columbia, said the delay is a source of confusion for his clients who have enrolled in the Coventry plan but are still waiting for their insurance cards and other pertinent information.

Mitchell's program is one of many nationwide that help HIV-positive patients secure federal funds through the Ryan White program to purchase health insurance.

But while patients may not have insurance cards, Coventry said they still have coverage.

"Any member who submitted an application by Jan. 1 and paid their January premium will have their services covered," Coventry spokesman Walt Cherniak told the Post-Dispatch on Monday. Hartford, Conn.-based Aetna Inc. owns Coventry.

That means Coventry will eventually pick up the bill once the paperwork is processed. In the interim, the same program that uses the federal grant to pay for the premiums for Ryan White members is paying for medical care and prescription drugs.

Statewide there are more than 2,000 HIV-positive individuals who benefit from the Ryan White program.

Healthcare Strategic Initiatives is the agent responsible for directing the federal funds to pay for the plans individuals select, but the process is complicated, said Meg Ebersoldt, a program coordinator for HSI.

HSI can't purchase plans in bulk or sign up individuals in bulk. The contract for a health plan is between the patient and the insurance company.

And, if there's a problem, there's no way to respond for all the enrollees.

There was confusion over whether enrollees had to sign a specific page in the paper application, and that is one reason it has slowed down the enrollment process, Ebersoldt said.

But Ryan White members are not the only Missourians experiencing issues.

Kelly Rector, an insurance broker with Denny and Associates, said it's hard to get medical care without an insurance card. One of her clients was denied an appointment with a doctor, until she got on the phone with the physician to explain the insurance paperwork was still being processed.

"I have spent numerous hours on the phone with Coventry over the past two weeks," Rector said of trying to resolve enrollment delays.

The only way to enroll in Coventry's off-exchange plan was by submitting a paper application, Rector said.

"They're just not making it easy," Rector said.

Rector said she's had to fax the same application multiple times.

And when she tries to resolve the issue by phone, there's no local representatives like there used to be, so Rector is left with calling an 800 number.

Aetna, which does business as Coventry in Missouri, stopped selling individual health plans on HealthCare.gov. This year, Coventry only offered one plan outside of HealthCare.gov: a PPO, or preferred provider organization, that lets individuals pick doctors in- and out-of-network.

Ryan White recipients were encouraged to sign up for the Coventry plan because it has a wide network of doctors and covers all the local hospitals.

Chelsea Arnott, a project manager at St. Louis Effort for AIDS, said unlike other plans, Coventry's provided coverage for specific prescriptions and access to St. Louis University's Infectious Disease Clinic, formerly known as New Hope Clinic.

Samantha Liss --314-340-8017

@samanthann on Twitter

[email protected]

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