Bright Health’s recent exit from the Summit County health insurance market has created a new gap in services for patients and insurance groups.
But with some of the best orthopedic surgeons in the world located at Vail-Summit Orthopedics & Neurosurgery facilities in Frisco, Colorado and operating out of Dillion Surgery Center, it certainly makes sense that local patients can access these services and not have to to travel to Metro Denver or beyond for other alternatives. And with enrollment open now in the state, patients looking to retain or secure access over the coming year are encouraged to do plenty of research to find a plan that will keep them in the community of VSON care.
Cari Thomason, VSON’s chief financial officer, says she works hard to try to provide options and education for patients who want localized access to surgery, sports medicine and more. But Thomason says patients need to take an equally proactive approach to securing their existing coverage, rather than facing unexpected billing issues in the future.
“Unfortunately, there just aren’t many local options, with only three insurers offering patients in-network coverage for our services in the individual market – Rocky Mountain Health Plans, part of the United Healthcare system, plus Anthem Blue’s plans go through Blue Shield and Cigna,” says Thomason. “Bright Health pulled out so quickly that many patients found themselves in trouble.”
Thomason says a big problem for patients is people who split their time between Denver and Summit County and believe — or hope — that their Front Range-based insurance coverage will automatically apply to VSON visits.
“Everything is completely different, depending on where you live and depending on the primary residence,” she says. “If you live in Denver, this plan may not be accepted here in Summit County. We run into this often, especially with Anthem’s CU health plan or even Kaiser Permanente, if people have coverage without extended networks.
Thomason encourages patients to do their research — as frustrating as it can be trying to call health insurance companies or dig through websites — to make sure their close network will cover VSON services.
“When planning your insurance choices, you need to focus on what you think your usage might be and how much you plan to spend, and determine the best plan for the care you plan to use,” says Thomason. “This is especially important if you have adult children who leave your insurance coverage as you approach 26.”
Amanda Leyrer, MS, ATC, OTC, SA, director of clinical operations for VSON, says VSON does its best to ensure that local patients have the easiest possible access to local orthopedic services.
“Our goal as an orthopedic practice is to provide care to the community, and we do what we can to help patients understand the local insurance market and get the best coverage possible,” she says.
Leyrer agrees that patients are still in a difficult position because many of these insurance decisions are ultimately left to them, with relatively little advice available.
“It’s especially difficult when insurance companies aren’t transparent to patients. A lot of it comes down to knowing what questions to ask and always doing your due diligence,” she says. “It’s important that people have coverage that allows for acute care, especially with our working population. Take the time to understand your benefits.
Leyrer suggests that potential patients with employer-sponsored insurance also pay close attention and prepare these questions for HR staff during open enrollment season, a time when a candid conversation with a knowledgeable attorney can help provide the right coverage – or avoid unexpected bills down the road.
“There are so many different variations of insurance out there, and they’re all trying to get some of the business, so you really need to know what you’re buying before making that choice,” adds Leyrer.
Leyrer says some patients may also benefit from the discount offered by paying for services in cash, but that also requires some foresight and may only be appropriate in some cases.
“We offer self-paid cashback on a case-by-case basis, and there are benefits to that, but it depends on the procedure. It is certainly another way to relieve.
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