Lac qui Parle County ‘out of network’

Feb. 13--DAWSON -- Living in Lac qui Parle County means more than being rural.

It also means being "out of network" for many farmers, business owners and others who purchase individual health insurance coverage through Blue Cross Blue Shield.

The entire county has been designated by state regulators as out of network for the policyholders. Unless they want to pay the bill on their own, the affected policyholders must obtain their health care services from out-of-county providers, except for emergency care.

"It is an access issue," said Stacey Lee, CEO of Johnson Memorial Health Services in Dawson.

The decision effectively means policyholders cannot access the rural county's two health systems, Johnson Memorial Healthcare Services in Dawson and Madison Healthcare Services in Madison. They must make 20- and 30-minute drives, and longer, to health care systems out of the county.

It's exactly the predicament that Kevin Lindblad, a farmer and lifelong county resident, found himself in when his son needed medical care in January. It's not just the inconvenience of traveling out of county, or in this case out-of-state to South Dakota, that upsets Lindblad. It also means being unable to see the health care providers his family has always seen and trusted, he pointed out.

"I'm not a rock-the-boat kind of person," said Lindblad, adding that in this case he intends to write a letter to elected officials in hopes they will right things for him.

Lindblad, 55, has been purchasing an independent health insurance plan for his family from Blue Cross Blue Shield for two decades. Last year his monthly premium was $1,350 for four children, spouse and himself. This year it was raised to $2,250 a month for three children and the two parents, and it includes a $13,000 deductible. Due to his son's health needs, he's already been advised he will meet his deductible by year's end. He's bracing for a total of $40,000 in health care costs this year. He purchased his policy through MNsure, although he did not qualify for any subsidy.

The dilemma is the result of limited options for those purchasing individual policies. The other main insurance provider, Medica, was allowed to cap its number of enrollees. State regulators allowed Blue Cross Blue Shield to "narrow" its network to help it control costs.

Lee questions whether allowing health insurance providers to narrow their networks will actually help control costs. "Irritating to us is that we have very high-quality scores and probably cost less than some of these bigger facilities that are 30-miles away," she said.

Dr. Ayaz Virji, M.D., chief of medical staff for Johnson Memorial, worries the affected policyholders will be less likely to seek preventative care, setting themselves up for higher medical costs in the long run. The need to travel will deter some. And, the lack of contact with their regular providers takes away a voice that might otherwise encourage them to seek preventative care.

The Dawson physician is especially concerned about how the quality of care will be affected for patients no longer visiting with their long-time care providers. There is a great deal of research showing the benefits of a strong doctor-patient relationship, he pointed out.

Johnson Memorial doesn't know how many of the people living in its service area are affected by the out-of-network dilemma. Lee said most of the affected policyholders are discovering the dilemma only when they need to schedule a health care appointment. Spouses of employees of the Dawson-Boyd Schools who were added to the group plan are learning they are among the affected, she said.

About 12 to 15 percent of the Johnson Memorial health system's patients are covered by Blue Cross Blue Shield, but a large portion of those people are on group plans and are unaffected.

The independent health care system is in the midst of an estimated $25.6 million building project, which adds to the concerns about a loss of patient revenue caused by the out-of-network dilemma. Johnson Memorial is one of the largest employers in Dawson, with 240 full- and part-time employees.

"Any loss of business for us hurts because we operate on very slim margins out here," said Lee.

Legislation offers some help, insurer speaks to challenge

DAWSON -- New legislation may provide some help for rural health care patients and providers finding themselves in the out-of-network dilemma.

Dawson area residents raised concerns about the out of network dilemma when State Senator Gary Dahms, R-Redwood Falls, and Representative Chris Swedzinski, R-Ghent, hosted a town hall meeting on Jan. 20 in Dawson.

Senator Dahms said the legislature approved and Governor Mark Dayton signed legislation that created an appeal process for out-of-network providers. They can bring their appeal to an administrative law judge and if successful, the state has set aside funds to help make them whole.

"Certainly not as good as I'd like to see it, but it's as good as we could come up with and still stay within the contractual agreements that are out there," said the senator.

The legislation also includes authority for agricultural cooperatives to provide group insurance programs for their members.

Both efforts are attempts to help see providers and consumers through 2017, Dahms explained.

Blue Cross Blue Shield is facing significant challenges providing coverage in Minnesota at this time. Eric Hoag, vice president of provider relations for Blue Cross and Blue Shield of Minnesota, outlined the company's situation in a statement to the Tribune for this article.

"The individual insurance market in Minnesota is very unstable right now. It's clear that Minnesota's individual market is not sustainable and that premium increases alone can't be the solution. For 2017, we believe our current ACO (Accountable Care Organization) offerings provide a needed level of stability while also serving as a bridge to a system that ultimately can offer greater choice among providers. I want to be clear that these provider access issues are limited to the individual market. We have agreements with many providers in Lac qui Parle and Kandiyohi counties that have Blue Cross members as patients though other markets, including employer-based coverage.

"To clarify, our ACOs are regional health insurance product attached to specific care systems throughout the state, each with its own network of affiliated providers. Each care system shares in the risk of their Blue Plus ACO product, so that's why it's necessary for Blue Cross and the care system to jointly determine which providers are in the network."

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